Education Journey of the Collector

Education Journey of the Collector

This document records the educational portfolio and collection-based learning activities submitted for evaluation, credit, or archival within the educational program. Applicant attests that the statements and materials provided are true and that all collection items are described accurately and lawfully possessed.

Student Information

Student Name:   Date of Birth:

Parent / Guardian (if Applicant is a Minor)

Applicant is under 18 years of age:

Collector Profile & Learning Objectives

Inventory of Collection (Representative Items)

Provide at least three representative items. Attach additional inventory on separate sheet if necessary.

Acquisition Date:   Method:   Estimated Value:

Acquisition Date:   Method:   Estimated Value:

Acquisition Date:   Method:   Estimated Value:

Exhibitions, Presentations, and Community Engagement

Mentor / Verifier

Mentor attests to the authenticity and educational relevance of submitted items:

Academic Review & Acknowledgments

By signing below the applicant acknowledges and agrees to the following statements (mark each box to indicate agreement):

I understand the portfolio will be reviewed by program faculty for educational credit, placement, or archival inclusion.

I certify that the collection items described are lawfully possessed and the descriptions are accurate to the best of my knowledge.

I consent to the use of photographs, scans, or descriptions of my materials for educational, exhibition, or archival purposes without financial compensation.

I agree to provide provenance, acquisition documentation, or additional evidence upon request by reviewers.

Legal Certifications and Indemnity

Certification of Authenticity: I certify under penalty of academic sanction that the materials and statements in this submission are true and accurate. I acknowledge that false statements or intentional misrepresentation may result in disciplinary action including revocation of awarded credit or program sanctions.

Intellectual Property and Reproduction: I represent that I hold or have secured appropriate rights to reproduce and submit images or descriptions of collection items and that submission of such materials does not infringe third-party intellectual property rights. I grant the educational institution a non-exclusive right to reproduce and display submitted materials for educational, archival, and promotional purposes.

Indemnification: To the fullest extent permitted by law, I agree to indemnify and hold harmless the educational institution, its employees, and agents from any liabilities, claims, demands, or expenses arising out of inaccurate statements, unlawful possession of materials, or third-party claims related to the submitted materials.

Privacy Notice: The information provided on this form will be used for academic review and program administration. Personal contact information will be kept confidential within program staff and used only for official communications related to this submission.

Optional Attachments

Additional inventory attached:

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