Student Spotlight

Student Spotlight Response Form

Thank you so much for being our “Student Spotlight”. Please answer the applicable questions below and sign off on the Western Illinois University Model Release Form at the bottom of the form.
Name:

First NameLast Name
Email:
example@example.com
Major:
Graduation Date (month/year):
What is your educational background? (straight from undergrad, taken gap year(s), have children, etc.)
Give some insight on your personal background:
What choices led you here to WIU?
When did you know you wanted to pursue a graduate degree Counselor Education or College Student Personnel?
Do you or did you have any limiting factors that impact your education? (children, disabilities, time, work, etc.)
How did WIU help you further your education?
Are you involved on campus? If so which campus and with what?
Fun facts about yourself:
Please upload 2-3 pictures (jpg format) of yourself, your family, your hobbies, you at WIU, pets, etc. Make it fun!

Cancelof
Image 2

Cancelof
Image 3

Cancelof
I, First Name Last Name , do hereby give Western Illinois University its assigns, licensees, and legal representatives the irrevocable right to use my name (or any fictional name), picture, portrait, photograph, and/or video image in all forms and media (including the Internet) by Western Illinois University, and I waive any right to inspect or approve the finished version(s), including written copy that may be created in connection therewith. I am an adult. I have read this release and am fully familiar with its contents.
Please sign below.

Clear
Should be Empty:

Student Spotlight Response Form