Potential Acquisition - Donor Questionnaire

First Name A value is required.*

Last Name A value is required.*

Mailing Address * (include contact person if applicable)
A value is required.

Telephone A value is required*

Email A value is required.Invalid format.*

Date of Birth A value is required.Invalid format.* mm/dd/yyyy

Are you the legal owner of items being offered? If not who is? A value is required.*

Item Description * (Please describe the items you wish to donate. Be specific including the estimated age, size, and condition of each item.)
A value is required.

Item History * (Write what you know about the items and their relationship to North Dakota: where / when / why / how the items were acquired and used; previous owners' names; relationship between owners; and most importantly, any PERSONAL STORIES about the items. (Why are they unique?))
A value is required.

Other Documentation Materials * (What photographs or other documentation do you have, or know of, that refers to any of the items you wish to donate?)
A value is required.

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Your information is for SHSND purposes only and will never be sold to anyone for any reason.