Donate Historical Items

Donation Form for Scientific Instruments

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. In developing exhibits, we try to explain 1) the operation of instruments and 2) their contribution towards a deeper understanding of biological phenomena. To this end, we must preserve not only a physical artifact but also 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. Instrument Name

Name:

III. Donor Information

Donor’s name:

Donor’s title:

Institute and laboratory:

Email:

Phone:

IV. Instrument Information

Building and room number or off-campus location:
Contact person for property transfer:
Property ID number:	Serial number:

Original cost ($)
Manufacturer and formal name of instrument:
Vernacular names, if applicable:
Date of manufacture:	Date acquired:

How long in use?
Has this instrument been modified? If so, please explain the nature of the changes:
Status of operational condition (defects):
Number and description of accessories and ancillary components:
Special operating or storage considerations (light/heat/etc.):
Special transportation concerns:
Safety concerns (hot sources, mercury, radiation, etc.):
Approximate weight and dimensions (send sketch if necessary):
URL for sketch (optional):

V. Distinctive Features of this Instrument

Did the instrument represent a technical advance in instrumentation? If so, please describe:
Was it the first of its kind?	Yes No
Was it one of a kind?	Yes No
Were new lines of investigation or assays developed around this device? If so, please describe:

VI. Documentation

Are the manuals for the instrument available?

In what laboratories was the instrument used?

Names of investigators/technicians who used this instrument:

VII. Additional Information

1. A curriculum vitae and picture for each key investigator who used the instrument.

None available:

Available for these people:

2. Copies of scientific articles that 1) describe the instrument and/or 2) typify the experiments performed with the instrument.

Will send articles:

No articles available. Here is a brief description of the research performed using this device:

Please note, if possible, main author, brief title, journal in which published, and year of publication for each key paper documenting the instrument: