Collecting COVID-19 Stories in Illinois – Submission Form The Illinois History and Lincoln Collections – Collecting COVID-19 Stories in Illinois The Illinois History and Lincoln Collections (IHLC) unit of the University of Illinois Library is collecting evidence of Illinoisans’ experiences with COVID-19. We invite you to share your journal and diary entries, emails, photographs, video and audio recordings, and other digital evidence of this period that reflect your personal thoughts and experiences. Please note that the IHLC is not accepting analog submissions at this time, but if you would like to donate physical items at a later date, please contact us. En Español - "Formulario de Envío" Please upload your files here. If you have more than one file to submit we recommend you zip your files, or you may submit this form more than once. Max file size is 10 MB. If your files are larger than 10 MB please still complete this form and contact the IHLC (email@example.com) so we can make arrangements for a file transfer. * Please describe the items that you are submitting to the IHLC. If you are uploading more than one item, please describe all the files: When did you create this document? Where was it created? What subjects or locations are depicted? Tell us the story behind this item. For example, why did you decide to create this document? How was this object used? What does this item/photo mean to you? How were you feeling when this was made/used? Please include any other useful information that will help future researchers understand your materials' creation and context. What types 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 If other please specify Tell us a bit about yourself to help provide future researchers with context for your materials. (This is optional) * 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 a co-creator form in order for the item to be accepted. However, only one co-creator is required to upload the file. Please share this form with your co-creators: https://go.library.illinois.edu/IHLCCoCreatorCOVID-19 Yes No * If appropriate, please list the names of the content co-creators, their contact information, and the circumstances of how you came to have the materials. (If this does not apply, please write "N/A" or "not applicable" in the space.) * Personal Information Agreement I understand and agree that the submitted material may contain sensitive personal information about me, including personal health information, and that this information may be archived and disseminated as described below. I agree not to include personally identifiable information of (or information that could allow a third party to identify) other persons unless they have submitted a signed consent form. * Submission Agreement I hereby certify that I created, and own the copyright in, the submitted material. While I will continue to retain my copyright, I hereby grant to the Illinois History and Lincoln Collections unit of the University of Illinois Library a nonexclusive right to authorize all uses of these materials for non-commercial research, scholarly, or other educational purposes in accordance with a Creative Commons Attribution, Non-commercial license. * I agree to permit public access to my submitted material (select one) Upon submission Five years after submission * I am over the age of eighteen. I have read the foregoing and fully understand the contents thereof Yes Full Name * How do you want your materials listed? Full name First name only Anonymous Other If other please specify Email Address (We will use this email only if we need to contact you with questions about your submission) Optional Demographics Questions The following questions are optional. This information will only be analyzed as aggregate data and will not be released with your materials. If you would like any of these details to be shared with researchers for context around you and your materials, please include them above in your response to "tell us a bit about yourself." Geographic location (city, state, country) Age 18-25 26-35 36-45 46-55 56-65 66-75 76+ What categories describe you? (Select all that apply) White Hispanic, Latinx, or Spanish origin Black or African American Asian American Indian or Alaska Native Middle Eastern or North African Native Hawaiian or Other Pacific Islander Some other race, ethnicity, or origin If other please specify Gender (please write in the line below) How did you learn about this project?