Western Illinois University: Macomb Campus

   *ALL FIELDS REQUIRED (If no answer available, type "N/A").

Your name:

Email:

Phone number:

(Feature stories, save-the-dates, ads, and news articles)
*ALL FIELDS REQUIRED (If no answer available, type "N/A").

Item Description/Title
(i.e., new faculty member article):

If submitting existing copy, paste body (or URL to existing copy) here:

If suggesting a story to be written, include COMPLETE details (who, what, when, why, how) here:

Reason/angle/newsworthiness of article suggestion:

Names of individuals featured in story to be interviewed/contacted:
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Individual 1 name:

Has the individual granted permission to be contacted for a story?:
Select One Yes No

Subject's WIU affiliation

Individual's role?:
Select One Faculty Staff Student Alumnus

Class year(s):

Major(s):

Current location (if alumni)
or hometown (if student):

Subject's contact information

Phone Number:

E-mail address:

Additional individuals

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Individual 2 name:

Has the individual granted permission to be contacted for a story?:
Select One N/A Yes No

Subject's WIU affiliation

Individual's role?:
Select One N/A Faculty Staff Student Alumnus

Class year(s):

Major(s):

Current location (if alumni)
or hometown (if student):

Subject's contact information

Phone Number:

E-mail address:

For additional individuals to contact, include all necessary details in "Other special instructions" field (below).

(Other necessary information relating to human subject of story)
*ALL FIELDS REQUIRED (If no answer available, type "N/A").

Has a representative of WIU had recent contact with the person to be interviewed?:

Select One Yes No

Please explain your recent contact from the question above:

Other special instructions before contacting subject(s)?:

Please give a short bio/background on the subject/person:

Website or other URL profile:

High-resolution photos have been submitted on a CD to University Relations:
Select One Yes No N/A No photos available

(Or) Lightbox photo path(s):