Your Information (So we may follow up your nomination)
Required information is indicated with an asterisk (*)

First Name: *

Last Name: *

Affiliation: *

Address1

Address2:

City:

Country:

State:

(if USA or Canada)

Zip Code:

Telephone: *

E-Mail Address:

   
Nominee Information

Nominee First Name:

Nominee Last Name:

Profession/ Position/ Title :

Organizations/ Affiliations :

   
I believe this individual merits an Honoary Doctoral Degree from Xavier University because: (please specifically address the criteria)
I also have other additional information (CV, Biography, PDF) I would like to submit, please contact me.