Donation/Loan Consideration Form – CPN Cultural Heritage Center

Date(Required)

Request Type(Required)

Donor/Lender(Required)

Phone(Required)

Email(Required)

Website

Potential Donor/Lender Statement

I have legal title/ownership and disposal rights of the item(s) described below, together with all copyright, trademark and associated rights. I understand that I cannot, under any circumstance, leave the item(s) at the Citizen Potawatomi Nation Cultural Heritage Center without proper consent and legal paperwork executed by both myself and the Cultural Heritage Center Collections and Research Division.

Digital Signature(Required)

Description of item(s)(Required)

Please include basic information, history, condition, size, etc.

Images of item(s)(Required)

Please include images of the item(s) listed above when submitting this form

Drop files here or

Accepted file types: jpg, jpeg, gif, png, heic, webp, pdf, Max. file size: 30 MB.