Westerville COVID-19 Memory Project
Fill out the form below to participate in this project. Thank you for helping us preserve COVID-19’s legacy for the Westerville community.

For more information, visit this page: https://www.westervillelibrary.org/coronavirus-memory
Email address *
Name (first & last) *
Address *
Date of submission *
MM
/
DD
/
YYYY
Phone *
Submitter's age range
Clear selection
Gender
Race/ethnicity
Occupation
Describe your COVID-19 experience below. *
Do you have any supplemental items to submit, such as a journal, letter, picture, video, or object?
Clear selection
If yes, send us an email with your name and attached files to westervillehistory@gmail.com. Then list them below, Including the date created & who created them.
Briefly describe the story behind these supplemental items.
Would you consider donating the physical versions of these items to the museum when it reopens?
Clear selection
Would you be willing to be contacted for follow-up, such as an oral history interview?
Clear selection
By submitting this form...
...you agree that you own and desire to give the Westerville History Center & Museum at the Westerville Public Library (WPL) your story & any supplemental files you submit via email, to be housed at the museum. Upon transfer to the WPL, the above described property is granted irrevocably and absolutely to the WPL. Any copyrights such as the donor may possess in this property or in any other property in custody of the WPL are hereby dedicated to the WPL. The WPL does not provide appraisal information for tax purposes. This remains the responsibility of the donor. You agree that the WPL and its employees shall have full and unrestricted use of these properties, and that these properties may be used in any manner deemed proper to promote the objectives of the Westerville History Center & Museum. These materials will be housed in the WPL. Any items within the donated collection which are not retained shall be returned to the donor or disposed of by the museum.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy