ICC Athletics Media Credential Request Form

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Itawamba Community College is an equal opportunity institution. For more information, contact the Vice President of Student Services, 602 West Hill Street, Fulton, MS 38843, 662.862.8271, or email TitleIXCoordinator@iccms.edu, or the full statement is available at https://www.iccms.edu/nondiscrimination.

First and Last Name *

Job Title/Role *

e.g., Reporter, Photographer, Videographer, Editor, On-Air Talent

Email *

Cell Phone Number *

for game-day contact if necessary

Media Outlet Name *

Media Outlet Website *

Primary Coverage Area *

Assigning Sports Editor / New Director Name, Email and Phone Number *

Sport(s) Requesting to Cover *

Baseball

Basketball

Cheer

Football

Golf

Soccer

Softball

Tennis

Volleyball

Row 1

Specific Needs Requested

Sideline/Baseline (photo/video only)

Press Box Seat (limited)

Access to Power Outlet

Hardline Internet Access (if available)

Parking Pass (if required)

Row 1

I certify that... *

I am a working member of the media assigned to cover Itawamba Community College athletic events for the outlet listed above. I have read, understand and agree to abide by Itawamba Community College's Media Credential Policies and Terms and Conditions. I understand that failure to comply may result in the revocation of credentials.

Required

I understand that... *

submission of this form is a request only and does not guarantee that a media credential will be issued. Itawamba Community College Athletics reserves the right to approve or deny any media credential request at its sole discretion. Applicants will be notified of the status of their request via email. Credentials are nontransferable.

Required

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