Date: I am: ___the Artist ___the Donor (check one or both)
Donor Name:
Artist Name:
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Donor Address:
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Home Phone:
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Cell Phone
E-mail Address:
_________________________________________________________________
Fax Number: Website:
Artist's birth year and City/State:
Artist's connection to Iowa:
Artist's current address:
Artist is an Alum: ___ Yes ___No If Yes, Campus: ____________ Date range: __________________
Donor is an Alum: ___ Yes ___No If Yes, Campus: _____________ Date range: ________________
Title of the artwork:
Date(s) artwork was created:
Where was art created? (e.g., studio, in the field, etc.):
Dimensions (HxWxD) in inches:
________ x _______ x ________
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Artist's death year (if applicable) and City/State: ___________________________________________
Thank you for your gift! SCC students, employees and visitors will benefit from your generosit.
ART DONATION FORM
Please provide as much detail as possible.
Information provided will complete our records on your donation to SCC's permanent art collection.
If No, what do you recommend (i.e., for type matting, frame, glass, pedestal, etc.?):
List all materials/media used:
Comments regarding the art:
Estimated value:
Please include/attach any personal history, resume, news clippings, or other information
that would
provide details about Donor/Artist &/or the donated work of art:
I agree to allow SCCACC to make reproductions of donated art for fundraising &/or promotion purposes: __Yes __No
Signature:
$________________________________________________________________
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Please return completed form to:
Phone: 319-208-5065 ~ Toll Free: 1-866-722-4692 ~ Email: foundation@scciowa.edu
www.scciowa.edu
Southeastern Community College Art Collectors Club
1500 W. Agency Road, West Burlington, IA 52655
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