CCHS Online Artifact Donation Form

CCHS Online Artifact Donation Form

Artifacts can be donated by the public. Please complete the form and submit it, along with photos of the item(s) for donation. All submissions are reviewed by the Collections and Exhibits Committee.
Condition Statement:

Thank you for your interest in donating objects to the Champaign County Historical Society.

Fill out all information boxes to the best of your knowlege.

Be sure that your browser (particularly Google) is up to date. An email will be sent to you immediately from noreply@jotform.com.
Name

First NameMiddle NameLast NameSuffix
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Collection Information
How did you obtain this object?

Other
If other, please explain
Object Information

Please fill out the form to the best of your knowledge.
What is the item, and where and how was this item acquired?
Who made the item? When and where? For what purpose?
Approximate date range of the object.
How old is this object?
What is the connection to Champaign County, Ohio?
What story does this tell that is important for Champaign County History?
Condition of the object?
Describe the condition and any damage or repairs made to the item(s).
Provenance (Ownership History) Information
Have there been other owners? What is your relationship to the previous owners? Please include dates and location if known, along with any additional background information on the item(s).
Upload 1 to 3 photos of the object(s)

Jpgs preferred. Size limit: 10MB.
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Are you a member of the Champaign County Historical Society?
Should be Empty:

CCHS Online Artifact Donation Form

Collection Information

Object Information

Provenance (Ownership History) Information