Date:   

Student Information
Last Name:      First Name:
Middle Name:      Suffix:
Preferred or Nickname:
High School:
High School City: High School State:

Parent Information
Last Name: First Name:
Address:
City: , State: , Zip:

The Public Relations Office periodically sends news releases on students’ academic accomplishments and honors to their hometown newspapers, with a copy to their parents.  A news release about freshmen entering Hampden-Sydney will be sent each summer. We would like to see every release in print, but the best chance is in a small community newspaper or a special section in a larger newspaper (for example, Charlotte Observer “Mecklenburg Neighbors”). Most metropolitan newspapers will not print this type of news due to the number of news releases they receive from schools, colleges, and universities. For this reason, we are asking for your help in identifying the newspapers most likely to print your son’s news releases.  If the newspaper is not in your hometown or the town in which your son attended high school, please clarify the reason it is being included. 

Newspapers Information
Community Newspaper #1:
P.O. Box or Street Address:   
City: , State: , Zip:

Community Newspaper #2:
P.O. Box or Street Address:    
City: , State: , Zip:

Metropolitan Newspaper & Section Name: (for example, College Honors, School Notes, Neighbors)
Metropolitan Newspaper name:
Section name:
P.O. Box or Street Address:   
City: , State: , Zip:

Listing of Parents
How would your son like his parent(s) listed in the release? (For example, “the son of Dr. & Mrs. John Doe,” “the son of John & Sally Doe,” “the son of Mrs. Sally Doe & the late John E. Doe,” etc. or, in the case of separated or divorced parents, “the son of Sally Smith of Birmingham and John Doe of Mobile.”)
“the son of: ”
Mother’s first name (required by some newspapers):
Other parent’s mailing address:
Other requests for news releases:

We appreciate your time and effort to help us give your son the recognition he deserves for his achievements.