Donate Historical Items

Donation Form for Non-scientific Artifacts

FORM
I. Purpose of Questions

The Stetten Museum collects, preserves, and interprets scientific instruments and non-scientific artifacts that played an important part in the history of biomedical research, with emphasis on the National Institutes of Health. To this end, we must preserve not only a physical artifact but also the knowledge associated with it. The more we know about historic artifacts, the more meaningful they are to future generations. Thank you for taking the time to assist us.

II. Description of Object

Description:

III. Donor Information

Donor’s name:

Donor’s title:

Institute and laboratory:

NIH address:

Email:

Phone:

IV. Present Location of Object

At NIH: Building:	Room:

Descriptive location if not in a room:
Off Campus: Location:
Current Custodian:

V. Information about the object

Historical narrative--please describe what is known about this object and why it is of historic importance (e.g. used in a dedication, retirement ceremony, etc.).

Special transportation concerns:

Approximate weight and dimensions (send sketch if necessary):

URL for sketch (optional):