Champaign County Historical Museum - Collection Application

To submit any artifact to be considered for donation to the Champaign Co Historical Society, we request that you complete and return the Collection Application and return it along with photos of the object to the museum by mail or in person to CCHS, 809 E. Lawn Ave., Urbana, OH 43078, or via email at champhistmus@ctcn.net for review by our collections and exhibits committee.

Collection Application.docx
File Size:	18 kb
File Type:	docx

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Or you may fill out our online Collection Donation Application and upload photos of the object on the form below.

Collection Donation Application

Contact Information

* Indicates required field

Name *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Collection Information

If "Other," please explain: *

When, where, and how was this item acquired? *

Object Information

Who made it? When and where? For what purpose? *

Approximate date range of the object. *

What is the object’s connection to Champaign Co.? *

Condition of the object. *

Additional provenance (ownership history) information

Have there been other owners? If so, what is your relationship to the previous owners? Please include dates and locations if known along with any background information known. *

Upload photo(s) of the object *

Max file size: 20MB

If needed, upload additional photos of the object. *

Max file size: 20MB

Upload File *

Max file size: 20MB

Submit

Collection Donation Application

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