Communication Sciences and Disorders Antiques Form

ASHA would like to honor its past by developing an ongoing museum-type historical display for our colleagues and community to enjoy. You can help! We are looking for members and friends with museum-quality artifacts they would give or loan to ASHA for this unique display, including photos, letters, old test instruments, old mirrors, and other materials that help depict the history of the Association in clinical services, research, and leadership.

We are not currently in need of books or journals unless they were first editions published before 1940.

If you have something to offer, please complete the form below describing your donation. Thank you for taking the time to participate in this project.

Items marked with an asterisk are required to submit the form.

Antique Information
1. What is the item?*
 
2. What is the purpose of the item?*
 
3. Is the item a real object or a model?*
 
4. What are the approximate dimensions of the item (height, width, and depth in centimeters if possible)?*
 

5. In what condition is the item?*
 
6. Who manufactured it?
7. When and where was it manufactured?
8. Who distributed it?
9. What makes this item interesting or historically significant either to the profession or to the association?*
 
10. Do you wish to donate the item to ASHA or lend it out for display?*
 
11. If lending, for what period of time?

Contact Information
Your name:*
 
How can we best contact you?
E-mail:
Phone:

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