Faculty/Staff Publicity Form

Faculty/Staff Publicity Form

West Virginia Wesleyan College
Submission Date

Month Day Year
Date
Full Name

First Name Middle Name Last Name
Title/Rank
Department/Office
Preferred Phone

Area Code Phone Number
Work Extension
E-mail
Home Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Years Employed at WVWC (include beginning date)
Please include any newspapers that would be interested in news concerning you (name of paper and city/state)
What subjects/interests would you be willing to discuss during an interview by the media?
I hereby authorize use of this information and/or any photos taken while at
Wesleyan by the Wesleyan Marketing and Communication and External
Relations Offices for news information, campus publications and press releases.
Should be Empty: