Chapman University Student-Athlete Questionnaire

This information is required from CURRENT CHAPMAN UNIVERSITY STUDENT ATHLETES and will be used by the Office of Sports Information for team rosters, press releases, media guides and various publicity functions of the university and the Department of Intercollegiate Athletics. We appreciate your help in filling out this form completely and in as much detail as possible.

(for rosters/media)
(Fr., So., Jr., Sr.)
(Fr., So., Jr., Sr.)
(i.e 2B, WR, D, 100 free, jumps)
(For baseball/softball)

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City, State
School (High), Sport (Soccer), Years (2007-09), Position(s) (DEF,GK)
Name & Year(s) attended
School (JC), Sport (Soccer), Years (2009), Postion(s) (GK)
Name of institution & years attended
School (Univ.), Sport (Soccer), Years (2010), Position(s) (GK)

ATHLETIC Honors & Rewards  - For each sport you've played list the honors and awards you've received, by year (varsity only). Include team, league, regional and national awards, along with outstanding statistics or team records. (Please list by year, sport, etc.)
(Ex. 2013-14 Baseball: All-Sunset League, team captain, led team in batting average)

ACADEMIC Honors & Awards  - Please list any awards on academic achievement (can be combined with athletic achievement, i.e. Scholar Athlete. Include Who's Who, honor societies, Deans Lists, scholarships, etc. (Please list by year)
(Ex. 2013-14: HS Scholar Athlete award)

For returners, please list any organizations, clubs or activities you are affiliated with on campus (i.e. greek life, peer tutoring, Relay for Life, Swing Club)
(Name, relation, years attended, sport)

This consent statement authorizes administrative personnel of the Department of Intercollegiate Athletics at Chapman University to review and disseminate to third parties information on this form and other education information contained, collected or maintained by Chapman University, for the purposes of public relations and publicity. The information on this form will assist in compilation of personal information for use in official departmental publications for the media and public, for the purposes of nominating me for honors programs, scholarships and awards, and for other public relations purposes deemed appropriate by officials of the Chapman University Department of Intercollegiate Athletics.


Also, by submitting this online form, I irrevocably authorize Chapman University, its employees, and its agents, to use my name, picture, and likeness as recorded by the University prior to the date of this Release for any purpose that the University deems appropriate, including promotional or advertising efforts. I specifically authorize the University, its employees, and its agents, to use, reproduce, exhibit, or distribute my name and likeness for such purpose in any communications medium currently existing or later created, including without limitation print media, television, and the Internet.

 
* = required field