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Loyola Medal - Nomination form
This is information about you, the nominator, so we can contact you with any questions.
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Email
(Required.)
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First name
(Required.)
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Last name
(Required.)
Concordia degree and year (if applicable)
Concordia title (if you are faculty/staff)
Address line 1
Address line 2
City
Province/State
Postal/Zip Code
Country
