Marietta College: Advancement

Alumni Office

College Relations Hometown Release Form

First Name*

Last Name*

Gender *

Major

Minor

Anticipated College Graduation Date

Home Address*	Address 2
City*	State*	Zip*

Mother's Name	Mother's Address
Father's Name	Father's Address

Hometown Paper Name	Hometown Paper Address
Hometown Paper Name (2)	Hometown Paper Address (2)

High School Name

High School Address

Please list any Grants and Scholarships that you are receiving from Marietta College.

Do you authorize Marietta College to use this information in news releases submitted to your hometown media?