Pope John XXIII Award Nomination Form

You may submit this online form to nominate a person for the Pope John XXIII Award for Distinguished Service or if you prefer, mail it to:

Pope John XXIII Award
Viterbo University
900 Viterbo Drive
La Crosse, WI 54601

 

Nominee:
 
Address:
Biographical
information:
Additional
information can
be obtained from:
   
Date:
Name of nominator:
 
Electronic signature of nominator: