Request for Art From the Department of Art & Design Office: _________________________ CSU location: ___________________________ Contact person: __________________ Phone number: __________________________ Email: _________________________ Answer the following to the best of your ability and / or □ check box for a consultation with the Gallery Curator. Type of art work preferred (circle one) Painting Drawing Sculpture Digital Media Fiber / Textile Art Photography Metals Ceramics Site specific Is this request for an installation that is temporary, rotating, or permanent? (circle one) Location of installation: ________________________________________________________ Type of wall / base at location: ___________________________________________________ Required frames, hanging devices, etc.: ____________________________________________ ____________________________________________________________________________ Equipment required: ___________________________________________________________ Workers required: _____________________________________________________________ Specific security issues: ________________________________________________________ Estimated cost of installation: ____________________________________________________ Budget number: _____________ Fiscal officer’s name: ______________________ Fiscal officer’s signature: ___________________ Completion Date Requested: ________________ Actual Date Completed: ______________ Mail form to BHS 600 Questions? Call x3984