Faculty/Staff Publicity Form
Please enter your name as you would like it to appear.
Full Name
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First Name
Last Name
Title/Rank
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Department/Office
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Preferred Phone
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-
Area Code
Phone Number
Work Extension
*
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 (include 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 & Communication Offices for news information, campus publications, social meda, and press releases.
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YES
NO
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