Meet St. Louis Intent Form Our application process is currently closed. Please check back in summer 2019. Itinerary Template The DEAR Model Civic Scholars Nomination Information Nominator's Information Nominator's First Name * Nominator's Last Name * Nominator's School or Department * Arts & Sciences Brown School McKelvey School of Engineering Olin Business School Sam Fox School of Design & Visual Arts School of Law School of Medicine OtherOther Nominator's Title Student Information Student's First Name * Student's Last Name * Student's Email Relationship of Nominator to Student * Ex. Academic Advisor Briefly, please share why this student is being nominated. (Note: your response is not required, and the information you share here will not be used in the program selection process.) Permission to Share Your Name with Nominee The Gephardt Institute has permission to share this nomination and the nominator's name with the nominee (Note: leave this checkbox unchecked if you wish your nomination to remain anonymous). If you are human, leave this field blank. This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Submit