Pacem Legacy Scholarship Online Nomination Form

This form is for Pacem Alumni ONLY

All Pacem alumni are encouraged to complete the online nomination form.
* Denotes Required Field

Divider Line

Nominator Section:

Last Name*:   First*:   MI:  

Address Line 1:   

Address Line 2:  

City:  

State/Province:  

Postal Code:  

Country:  

Countries of Citizenship:  

Telephone Number (including Area Code):  

E-mail Address*:  

What year(s) did you attend La Roche University?  

Current Occupation:  

Please provide us with a small quote about your Pacem in Terris experience:
  

Divider Line

Nominee Section:

Last Name*:   First*:   MI:  

Address Line 1:   

Address Line 2:  

City:  

State/Province:   

Postal Code:  

Country:  

Countries of Citizenship:  

Telephone Number (including Area Code):   

E-mail Address:   

What is the best method for reaching the nominee? 
 

Divider Line

Please answer the following questions regarding the nominated student:

 

1. What is your relationship with the student?
        

2. Why did you nominate this student?
        

3. What qualities can the nominated student bring to La Roche?