Thank you for your time in providing information for this form. This form will provide valuable information to the public information office and the sports information director at Northeast Mississippi Community College. It will be used to supply information to hometown newspapers in press releases; in pitching feature stories; in media guides; and on the NEMCC web site. The more we know about you, the better we can promote the college and its student-athletes.
 

NOTE: All form boxes that are outlined in red are REQUIRED fields and the form cannot be submitted without filling out those forms. 
 

Please remember to confirm your form once you hit the submit key, hitting the submit key only saves your answers until you confirm your form. If successful, you should receive a confirmation page of the form being submitted.

 

STUDENT-ATHLETE CONTACT INFORMATION

  

Full Name:

Sport (Specify men's or women's):

Position:

Year at NEMCC: (Freshman, Sophomore, etc.)

Name as you would like it to appear in publications:

(Ex. Mike instead of Michael)

Permanent Address:

City:

State:

Zip Code:

Home Phone:

Cell Phone:

Email Address:

HIGH SCHOOL INFORMATION

  

High School:

High School Mascot:

Sports played in high school:

High School Stats and Athletic Accomplishments:

(PLEASE BE SPECIFIC:

Spell out conference and state affiliations.

Please separate sport accomplishments.)

TRANSFERS

COLLEGE OR JUNIOR COLLEGE INFORMATION
 
DOES NOT APPLY TO INCOMING FRESHMEN

  

College or Junior College:

Sports played:

Other College Stats and Accomplishments:

TRAVEL, CLUB OR AAU TEAM INFORMATION

  

Travel Team, Club Team or AAU Team:

Travel, Club or AAU Stats and Accomplishments:

ACADEMIC INFORMATION

  

Academic Accomplishments:

(Ex. Honor Roll)

Clubs and Organizations:

PERSONAL INFORMATION

  

Major:

Height:

Weight: (men only)

Parent's Names:

(If you have step-parents, please include and specify)

Did your parent(s) play a sport in college?

If yes, list where, when, the sport and any honors:

Siblings:

If you have sibilings in college,

do they participate in sports?

Also, any professional playing experience with details:

   



































































































































Any questions or for additional information, contact Blake Long, NEMCC Sports Information Director at bdlong@nemcc.edu
 

By clicking the submit button below, you signify you authorize the sports information department at Northeast Mississippi Community College (NEMCC) to use all of the information listed above, as well as photographs and any other present or future information about me as a student-athlete at NEMCC for sports publicity and information purposes. I grant this authorization as a waiver to my rights under the Education Ammendment of 1972 to restrict the release of information to persons outside the university or college spectrum. I also acknowledge personal information such as phone numbers and addresses are for office use only.

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