Ukrainian Archival, Cultural, and Scientific Collections At-Risk
The US Department of State, the Interagency Working Group on Scientific Collections (IWGSC), the US Department of Agriculture (USDA), and the Smithsonian Cultural Rescue Initiative (SCRI) are working together to help identify, and where possible save/protect priceless Ukrainian archival, cultural, and scientific collections under threat.

Please complete the collection-specific information below to the best of your ability. One form should be submitted for each collection.

For questions, please contact Katelynn Averyt - Smithsonian Institution at AverytK@si.edu.

Sign in to Google to save your progress. Learn more
Your First Name (person submitting this form) *
Your Last Name (person submitting this form) *
Your Email Address (person submitting this form) *
𝗖𝗢𝗟𝗟𝗘𝗖𝗧𝗜𝗢𝗡𝗦 𝗜𝗡𝗙𝗢𝗥𝗠𝗔𝗧𝗜𝗢𝗡
Please complete the collections-specific information below.
Collection Name (in Ukrainian)
Collection Name (in English)
Do you know of any immediate, urgent needs for this collection? *
If yes, please provide additional details in the "Additional Notes" section at the end of the form.
Please indicate the type of collection (check all that apply).
Collection Address (Street Address)
Collection Address (City)
Collection Address (Postal Code)
Collection Address (Latitude)
Please use simple standard decimal coordinates such as 48.379433
Collection Address (Longitude)
 Please use simple standard decimal coordinates such as 31.16558
Collection Affiliation
Collection Web Address
Physical Size of the Collection
Please include unit of measurement.  This may depend on the collection, i.e. cubic meters, shelf meters for books, etc.
Number of samples, accessions, etc. in the collection
Please include unit of measurement
Special needs (e.g., equipment, freezing, refrigeration, live specimen)
Do you have dedicated data backup needs (i.e. servers destroyed or corrupted)?
Clear selection
𝗣𝗢𝗜𝗡𝗧𝗦 𝗢𝗙 𝗖𝗢𝗡𝗧𝗔𝗖𝗧
Please complete the information below for Ukrainian, United States, and USG Expert points of contact.
Ukrainian Point of Contact (First Name)
Ukrainian Point of Contact (Last Name)
Ukrainian Point of Contact  - Email Address
Ukrainian Point of Contact - Phone Number
Please enter full number, including country code and area code
Ukrainian Point of Contact - Physical Location
United States Point of Contact (First Name)
United States Point of Contact (Last Name)
United States Point of Contact - Email Address
United States Point of Contact - Phone Number
Please enter full number, inclusive of country code and area code.
United States Point of Contact - Affiliation
Independent validation by USG expert recommended?
Clear selection
USG Expert Name (First Name)
USG Expert Name (Last Name)
USG Expert - Phone Number
Please enter full phone number inclusive of country code and area code
USG Expert - Email Address
𝐀𝐝𝐝𝐢𝐭𝐢𝐨𝐧𝐚𝐥 𝐍𝐨𝐭𝐞𝐬:  Please include any additional relevant information that was not previously captured.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Foreign Affairs Network. Report Abuse
Google Forms