COVID-19 Tell Your Story Submission form for non-Google account users

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Case Western Reserve University Kelvin Smith Library is seeking to document the personal experiences of our students, faculty, staff, alumni, and other campus members during the COVID-19 coronavirus pandemic. We invite you, the campus community, to record your stories and contribute them to the University Archives for preservation and a place in the university’s historical record.

Users without a Google account cannot upload their files directly using this form. Please email University Archives staff at archives@case.edu for alternative transfer methods.

Email *

What is your full name (first, middle, and last?) *

What is your preferred form of your name if different from above? If you want your materials to remain anonymous, enter "Anonymous"

Geographic location (city, state, country)

Age

18-30

31-50

51-69

70+

Clear selection

Gender identity

Female

Male

Gender neutral

Clear selection

Check all that apply. Other can include retired faculty and staff, contractors, trustees, volunteers and other members of campus community. *

Alumni

Faculty (all ranks and designations, e.g., full-time, part-time, adjunct, clinical, etc.)

Staff

Students

Other:

Required

Are you the sole creator of these materials? If "no" or "other" please list the names of the content co-creators, their contact information, and the circumstances of how you came to have the materials. IMPORTANT: Each co-creator must fill out this form in order for the item to be accepted by the archives. However, only one co-creator is required to transfer the file. *

Yes

Other:

What type(s) of files are you submitting? (Select as many as necessary) *

Photos (e.g., tif, jpeg)

Video (e.g., mp4, mov)

Audio (e.g., mp3)

Text (e.g., pdf, Word, etc.)

Other:

Required

Please describe your items, including locations, event, dates, and names of people included. Some examples: (1) pictures of my roommate (name) and me packing and moving out of dorm, 3/21/2020. (2) Journal I kept of my isolation experiences, 3/25-4/25/2020. (3) Video diary I kept of end of Spring semester 2020. *

If you will be submitting analog items, please check here and read the message at the bottom of this form.

I will submit analog items to the University Archives

Personal Information Agreement *

I understand and agree that the submitted material may contain personal or health information that identifies who I am and that the material I submit may be archived and disseminated as described below. I will not include personal or health information of, or information that could allow a third party to identify, other persons unless they have submitted a signed consent form.

Required

Submission/Donor Agreement *

I hereby certify that I created, and own the copyright for, the submitted material. While I will continue to retain my copyright, I hereby grant to Case Western Reserve University a revocable license to add the material to its archival collections in the University Archives and preserve it for future generations of students, scholars, and researchers. I give CWRU permission to organize the materials according to accepted archival principles; to create metadata, finding aids, and full-text search interfaces required for the preservation and discovery of the materials; to make the materials accessible to researchers and staff; and to use the materials in exhibits and displays, both physical and online. I agree that Case Western Reserve University may make this material available online under a Creative Commons Attribution 4.0 license (https://creativecommons.org/licenses/by/4.0/) or any similar license, which will allow others to share and adapt the material, as long as I am given appropriate credit. I can withdraw my consent by contacting the University Archives in writing; however, I understand that withdrawal of consent only applies to dissemination after the date University Archives receives the withdrawal of consent and will not affect dissemination that occurred up to the date of receipt of the notice of withdrawal.

Required

I agree to permit access to my submitted material (select one) *

Upon submission

5 years after submission

Submission procedures

If your file sizes are higher than 10MB contact the University Archives (archives@case.edu) and we can make arrangements for file transfer. If your submission is in analog form (for example, a handwritten diary) you are welcome to either drop it off at the CWRU Archives or mail it to the following address when we return to campus after the Spring, 2020 COVID-19 closure:
Case Western Reserve University Archives
20 BioEnterprise building
10900 Euclid Avenue
Cleveland, OH 44106-7229

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