Load Request

Loan Request

Please attach a CV, a short research proposal (1-2 paragraphs) and any other supporting documents (letters of recommendation, publications, etc.) along with this application. If you are a student, please also attach a letter of recommendation from your head supervisor. Please state in the form and research proposal if the specimen will be housed and/or handled by another researcher/institution.

Name*

First NameLast Name

Organization

Title

If a Student, Name and Title of your supervisor

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email Address*

example@example.com

Phone Number

Please enter a valid phone number.

Specific information about specimens, artifacts or documents requested (include accession numbers

Intended use of materials

Length of Loan

If specimens loaned by The Children’s Museum of Indianapolis are to studied in institutions other than that listed above, please note the name and address of any/all institutions, along with estimated dates at institution and point of contact for institution, along with reason for the change and what research is being performed

Are you planning any analyses or procedures that would alter the specimen/object?

YesNo

If Yes, please fill out the Invasive/Destructive Analyses form and include with your Loan Invoice.

Are you planning to use any scans (2D or 3D) for use in research or exhibit?

YesNo

If Yes, please consult the TCMI policies on Imaging and Reproduction and fill out an Imaging and Reproduction form with your Loan Invoice.

Documents

Files types: pdf, doc, docx. | Max number of documents: 10