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<h2><strong>LIS Digitization Intake Form</strong><br /></h2>
<table width="675" border="0" cellspacing="2" cellpadding="2">
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<div align="right">Applicant Name</div>
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<td><input type="text" name="Name" id="Name" /></td>
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<div align="right">Email</div>
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<td><input type="text" name="Email" id="Email" /></td>
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<div align="right">Phone</div>
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<td><input type="text" name="Phone" id="Phone" /></td>
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<td colspan="3">The Intake Form is required for all projects whether a collection or single item to begin the digitization process. Please fill out as accurately and completely as possible. Consult with the Digital Imaging Specialist regarding technical questions. No projects will be assessed or projects initiated until the form is completed. The information requested here is vital to the process of selection and to the process of creating and managing digital collections.</td>
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<td colspan="3">1.Name: Name of physical collection, materials, or item(s) proposed for digitization (include dates):</td>
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<td colspan="3"><textarea name="name of collection" id="name of collection" cols="100" rows="5"></textarea></td>
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<td colspan="3">Repository Name: Name of repository, subject collection, etc., where held:</td>
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<td colspan="3"><textarea name="repository name" id="repository name" cols="100" rows="5"></textarea></td>
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<td colspan="3">Repository Contact: Name of contact at the holding repository, telephone number and email<br /> address:</td>
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<td colspan="3"><textarea name="repository contact" id="repository contact" cols="100" rows="5"></textarea></td>
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<td colspan="3">2. Funding/Time Frame: Are there grant funds or deadlines involved in the project? If so, what is<br /> the timeframe or target publishing date?</td>
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<td colspan="3"><textarea name="fuding time frame" id="fuding time frame" cols="100" rows="5"></textarea></td>
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<td colspan="3">3.Type: Type of collection, materials, or items(s) (Check all that apply.)</td>
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<td width="33%"><input type="checkbox" name="book" id="book" />Book</td>
<td width="33%"><input type="checkbox" name="pamphlet" id="pamphlet" />Pamphlet</td>
<td width="33%"><input type="checkbox" name="typescript" id="typescript" />Typescript (typewritten Documents)</td>
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<td><input type="checkbox" name="manuscript" id="manuscript" />Manuscript (handwritten documents, letters, etc.)</td>
<td><input type="checkbox" name="photographs" id="photographs" />Photographs</td>
<td><input type="checkbox" name="maps-broadsides-posters" id="maps-broadsides-posters" />Maps/Broadsides/Posters</td>
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<td><input type="checkbox" name="negatives" id="negatives" />Negatives</td>
<td><input type="checkbox" name="slides" id="slides" />Slides</td>
<td><input type="checkbox" name="film" id="film" />Film</td>
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<td><input type="checkbox" name="audio" id="audio" />Audio</td>
<td><input type="checkbox" name="video" id="video" />Video</td>
<td></td>
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<td colspan="3"><input type="checkbox" name="other" id="other" />Other (please describe)</td>
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<td colspan="3"><textarea name="other type of collection" id="other type of collection" cols="100" rows="5"></textarea></td>
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<td colspan="3">4.Project Type Details: If Photographs or Maps/Broadsides/Posters are checked for question 2,<br /> provide the type and average size. Please include physical size of largest image. If audio or video is<br /> checked, provide specific information on the format (tape, record, disc, etc.), technical aspects of<br /> the format (size of tape or disc, playing speed, etc.), and equipment needed to play the format.</td>
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<td colspan="3"><textarea name="project type details" id="project type details" cols="100" rows="5"></textarea></td>
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<td colspan="3">5.Project Information: Information about the project, materials, or items(s) proposed (indicate<br /> extent of the collection/number of items, number of pages, include page numbers if part of a larger<br /> work, date or date range, creator, the collection and/or series names, box, folder, and/or item<br /> control numbers or equivalent, and bibliographic citation or other information).</td>
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<td colspan="3"><textarea name="project information" id="project information" cols="100" rows="5"></textarea></td>
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<td colspan="3">6.Metadata: Is the collection, materials, or items(s) described by:</td>
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<td colspan="3"><input type="checkbox" name="catalog record in CARLI" id="catalog record in CARLI" />A catalog record in CARLI or another system?</td>
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<td colspan="3"><input type="checkbox" name="Finding Aid" id="Finding Aid" />A finding aid?</td>
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<td colspan="3"><input type="checkbox" name="other descriptive records" id="other descriptive records" />Another descriptive format or record(s)? (please describe)</td>
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<td colspan="3"></td>
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<td colspan="3"><textarea name="Describe publication status" id="Describe publication status" cols="100" rows="5"></textarea></td>
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<td colspan="3"></td>
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<td colspan="3">7. Publication Status: Are the materials</td>
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<td colspan="3"><input type="checkbox" name="unpublished" id="unpublished" />Unpublished?</td>
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<td colspan="3"><input type="checkbox" name="published" id="published" />Published?</td>
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<td colspan="3">Please Describe:</td>
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<td colspan="3"><textarea name="Describe publication status" id="Describe publication status1" cols="100" rows="5"></textarea></td>
</tr>
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<td colspan="3">8. Transcription Information: Does a transcription of the materials exist in paper or electronic<br /> form? If in electronic form, please list the format.</td>
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<td colspan="3"><textarea name="transcription information" id="transcription information" cols="100" rows="5"></textarea></td>
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<td colspan="3">9. Nomination Reason: Describe why the materials are important, who might want to use them in<br /> a digital form, and what usages are likely if they are digitized.</td>
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<td colspan="3"><textarea name="Nomination Reason" id="Nomination Reason" cols="100" rows="5"></textarea></td>
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<td colspan="3">10. Restrictions: Indicate if you are aware of any reason the materials should not be digitized, such<br /> as copyright or other legal restrictions, contractual, or ethical reasons, or issues of cultural sensitivity.</td>
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<td colspan="3"><textarea name="Restrictions" id="Restrictions" cols="100" rows="5"></textarea></td>
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<td colspan="3">11. Preservation Concerns: Are there any preservation concerns associated with the collection?<br /> (Rapidly deteriorating materials or formats, materials that require special handling, etc.)</td>
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<td colspan="3"><textarea name="Preservation Concerns" id="Preservation Concerns" cols="100" rows="5"></textarea></td>
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<td colspan="3">12. Additional Information: Please indicate if you have any special knowledge or skills that might be<br /> shared during the selection process - can you provide descriptive information, historical<br /> background, or are you aware of potential funding sources or other digital projects working with<br /> similar materials?</td>
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<td colspan="3"><textarea name="Additional Information" id="Additional Information" cols="100" rows="5"></textarea></td>
</tr>
</table>
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