In an effort to assist the Office of Athletic Communications in generating publicity for Wentworth student-athletes and teams, we ask that you fill this form out. Many of these fields are required and the form will not be able to be submitted unless any errors have been corrected. Student-athletes will not eligible to practice with their teams until all paperwork, including this form, is on file.

Please note that you will have to confirm your submission before submitting it and, if the submission is successful, you will receive an email to the address you provided.

PLEASE USE PROPER CAPITALIZATION THROUGHOUT THIS FORM

Today's Date *

Please enter in the following format: MM/DD/YYYY

You are a candidate for which sport(s)? *

Name and Address

First Name *

Middle Initial *

Last Name *

How would you like your name to appear on a roster *

Example: Jim instead of James

Pronunciation *

Please provide a phonetic pronunciation of your first and last names

Wentworth W Number *

(please use all leader zeroes)

Wentworth Address *

Building/room or off-campus address with city and state

Home (Legal) Address *

This is NOT your Wentworth address

City *

State *

Country *

Zip/Postal Code *

E-Mail Address *

Cell Phone Number *

Please use this format: (XXX) XXX-XXXX

Home Phone Number *

Please use this format: (XXX) XXX-XXXX

Parents' Names *

Address *

Names of siblings *

Vitals

Major *

Please use the full name of your major, not the abbreviation

Date of Birth *

Please use the following format MM/DD/YYYY

Class Year *

Freshman Sophomore Junior Senior Fifth Year Graduate

What year will you graduate from Wentworth (undergraduates only)? *

Position(s) *

If more than one sport, please separate positions by using a comma

Height *

Please use the following format X-XX (i.e. 5-10)

Weight

Men's teams only - enter a number only

Desired Uniform Number

if applicable

Bats/Throws

Baseball/Softball only

L/L L/R R/L R/R S/L S/R

High School *

City, State *

Year Graduated *

Prep School (if applicable)

City, State

Year(s) Attended

Last team played for

Ice hockey ONLY; please provide the full name of the team and the affiliated league

Have you read and understood all of the policies contained in the Student-Athlete Handbook as well as all other student-athlete policies? *

The handbook and policies can be found at http://www.wentworthathletics.com/current/index, under "Student-Athlete Policies"

Yes No

PLEASE READ

By signing this form, you authorize the Wentworth Institute of Technology Office of Athletic Communications to release information about yourself, and your team, pertaining to athletic and academic awards to hometown, regional and national media outlets for the sole purpose of publicity. You understand that disclosure of information regarding yourself will fall within the guidelines of the Family Educational Right to Privacy Act (FERPA). Furthermore, you authorize the use of your likeness (e.g., photographs) in whatever manner deemed necessary (e.g., website, publications) by the Office of Athletic Communications, Department of Athletics and Institute.

Email address *

First name *

Last name *

* required field

2023-2024 Returning Student-Athlete Biographical Form

PLEASE USE PROPER CAPITALIZATION THROUGHOUT THIS FORM

Name and Address

Vitals

PLEASE READ