If we have sent you a tile, there is a label on the back with a number on it. Please fill out as much information as you can. You can email it to info1@cforat.org or fvalesco@cforat.org or include a printed copy of this sheet in your package.
Tile Number (on the back of the tile) __________
Top Section
First name ______________________________
Last name ______________________________
Date __________________
Phone/TTY _____________________________
Address _______________________________
City ___________________________________
State __________________
Zip ____________________
Email _________________________________
Bottom Section
Please try to think of at least three keywords that describe your tile. Examples might be family, wheelchair, overcome. You can add more information on a separate piece of paper. This might include a description or explanation of the subject in your tile, something about you or the person who made the tile, and anything else you would like us to know.
Keyword #1____________________________
Keyword #2 ___________________________
Keyword #3 ___________________________
Let us know if you have used any of the materials listed below to finish your tile. If you prefer, we will put a protective seal on your work.
Acrylic varnish (some good brands are Liquitex, Golden, Nova)____gloss _____ matte_____ other (please specify)
Anti-graffiti varnish ______________________________brand
Please varnish tile for me ____________
Additional information
Materials used in the work (paint, markers, collage, etc.) __________________________________________
Title (if any) _______________________________________
If you are sending us your own tile that meets the guidelines (see "The Disability Mural Technical Guidelines"), include the above information on a separate piece of paper with your tile. You can also attach a label to the back of your tile.
Return all material to:
CENTER FOR ACCESSIBLE TECHNOLOGY
2547 8TH STREET, SUITE 12-A
BERKELEY, CALIFORNIA 94710
If you have any questions, email us at info1@cforat.org, visit the website, http://www.cforat.org, or call 510-841-3324 (voice) or 510-841-5621 (TTY)
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