Alumni Art Submission - Mount Vernon Nazarene University

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University   A dvancement   a nd   A lumni   R elations   |   8 00   M artinsburg   R oad   |   M ount   V ernon,   O H   4 3050  

800-­‐367-­‐9294   |   7 40-­‐397-­‐9000,   e xt.   4 300   |   d evelopment@mvnu.edu   |   g iving.mvnu.edu  

 

Please   b ring   t his   f orm   w ith   y ou   w hen   y ou   d rop   o ff   y our   a rt.  

 

ARTIST   I NFORMATION:  

Artist   N ame:      

 

 

 

 

 

 

 

 

 

 

 

 

 

Artist   A ddress:      

 

 

 

 

 

 

 

 

 

 

 

 

 

Artist   P hone   # :      

 

 

 

 

  A rtist   E mail:      

 

 

 

 

______  

Artist   A lumni   Y ear   ( if   M VNU   g raduate):   _ __________________________________________  

Donated   b y   A rtist?     Y es     N o    

 

I   w ould   l ike   t o   r emain   a nonymous?       Y es     N o  

Artist   G allery   A ffiliation   ( Please   l ist   n ame   o f   G allery   i f   a ny):    

 

________  

 

 

 

 

 

ART   D ONATION   I NFORMATION:    

Item   N ame:    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type   o f   A rtwork:    

 

 

 

 

______________________________________________  

 

Item   D escription:    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Medium:    

 

 

 

 

 

Size:      

 

 

 

 

 

 

 

Suggested   O pening   B id:   _ _________________________  

 

Estimated   F air   M arket   V alue:   _ _______________________   ( to   b e   p rovided   b y   d onor)  

Please   c heck   o ne:          D onor   s tatement   o f   v alue              A ppraisal   a ttached   ( for   i tems   v alued   a t   $ 5,000+)              R eceipt   a ttached  

PLEASE   N OTE:   T he   v alue   o f   a ny   i tem,   r egardless   o f   t he   a mount,   i s   u sed   f or   i nternal   g ift   r eporting   o nly.   M VNU   i s  

unable   t o   i nclude   t he   e stimated   v alue   o n   a   d onor   r eceipt   o r   a cknowledgement.   I t   i s   t he   r esponsibility   o f   t he   d onor   t o  

substantiate   t he   f air   m arket   v alue   f or   h is/her   o wn   t ax   p urposes.  

 

Donor   S ignature:    

 

 

 

 

 

 

        D ate:    

 

 

 

 

 

 

For   I nternal   U se  

 

Photo   T aken   ( circle   o ne):           Y es             N o  

 

Received   B y:   _ __________________________________________________________________   D ate:   _ _________________________________