Fillable Form 110 Request For Collections Use (Idaho State University)

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Form 110 Request For Collections Use (Idaho State University)

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The Form 110 Request For Collections Use (Idaho State University) form is 1 page long and contains:

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  • 12 check-boxes
  • 18 other fields

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File type: PDF

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Distribution: Registrar Division Applicant IMNH Form No. 110.2 January 2017
Idaho State University • 921 South 8
th
Avenue, Mail Stop 8096 • Pocatello, ID 83209-8096
(208) 282-3168 phone • (208) 282-5893 fax • imnh@isu.edu
REQUEST FOR COLLECTIONS USE
NAME:
DATE:
ADDRESS:
CITY, STATE, ZIP CODE:
TELEPHONE:
EMAIL:
PROFESSIONAL AFFILIATION (if applicable):
Institution (name and city):
Position:
Major Advisor (students only):
Major Advisor Contact Info:
ACCESS REQUESTED TO COLLECTIONS (Objects and/or documentation) from (please check appropriate Division):
Anthropology Earth Sciences Life Sciences Museum Archives Idaho Virtualization Laboratory
Earl H. Swanson Archaeological Repository John A. White Paleontological Repository
Is the project funded by a Grant or Contract?
Yes No
If yes, name of funding agency:
PURPOSE (include collection(s) to be accessed, if known):
PROPOSED ACCESS DATE:
This form is to be used as a request only. If the request is approved, additional forms may be required. Please allow two
weeks for processing. The completed form can be mailed to the address provided above, or emailed to imnh@isu.edu. Any
publications or products resulting from access to collections must provide ownership credit to the Idaho Museum of Natural
History and the appropriate federal agency, if applicable. One digital, or two archival, hard copies of any publications or
products must be provided to IMNH upon completion of the project.
FOR OFFICE USE ONLY
APPROVED BY:
DATE:
TITLE:
ACTION TAKEN:
DATE:
FEES ASSIGNED:
*A statement of support from the Major Advisor must be submitted with all student access requests.
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Form 110 Request For Collections Use (Idaho State University)

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Completed 25 July 2020

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