The Quilts and Health Documentation Form ○ choose only one  choose as many as apply Project number: Owner’s name for quilt: Name(s) for quilt’s pattern in common use: Subject of quilt:

Museum accession number: and/or Quilt’s title: Source of pattern name: (Brackman number)

Artist statement and/or stories about the quilt and the artist

Written by: Date written: Feel free to attach extra sheets of paper if you need more room. Who made the quilt? Quilt top made by: Other people who worked on this quilt: If quilting group, group name: Group’s founding date: Unique characteristics of the group:

Quilted by: Group’s ending date:

If you are a relative of the quiltmaker, how are you related? The quiltmaker is my:  Wife  Grandmother  Sister  Mother  Great-grandmother  Aunt

 Unknown but from my family  Unknown but from my spouse’s family

Other relationship:

Where was the quilt made? City: Reservation:

County: Province:

State: Country:

When was the quilt made? Time period:

○ Pre-1799 ○ 1850-1875 ○ 1901-1929 ○ 1950-1975 ○ 2000-2025 ○ 1800-1849 ○ 1876-1900 ○ 1930-1949 ○ 1976-1999 ○ Timepsan

Date quilt finished: Date quilt begun: Further information concerning date(s):

The Quilt Index: http://www.quiltindex.org/

Family/owner’s date for quilt:

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The Quilts and Health Documentation Form ○ choose only one  choose as many as apply Why was the quilt made?  Art or personal expression  Anniversary  Autograph or friendship  Baby or crib  Challenge or contest entry Please explain:

 Commemorative  Fundraising  Gift or presentation  Home decoration  Memorial

 Artwork/wall hanging Quilt is presently  Bedding, daily use used as:  Bedding, special occasion  Decorative throw Other present use(s) of quilt:

 Mourning  Personal enjoyment  Personal income  Reunion  Teaching or learning sample

 Doll quilt/toy  Exhibit  Inventory/dealer stock  Investment

 Therapy  Wedding  Unknown  Not described  Other

 Keepsake/memento  Lap robe/shawl  Museum collection  Room decoration

 Study or teaching aid  Unknown  Other collection  Other

Quiltmaker’s information Gender:  Female  Male  Group County: Street address: City: State: Province: Reservation: Zip or Postal Code: Country: Quiltmaker’s maiden name: Birth date: Birth place: In which kind of environment did the quiltmaker grow up:  Rural  Urban Ethnic background/tribal affiliation: Educational background: Religious affiliation: Occupation (include any specific health and well being roles): Father’s name: Father’s ethnic/tribal background: Mother’s name: Mother’s ethnic/tribal background:

Phone number: Death date:

Father’s birthplace: Mother’s birthplace:

Marriage date(s): Spouse’s/spouses’ name(s): Spouse’s/spouses’ ethnic/tribal background: Spouse’s/spouses’ occupation: How did the quiltmaker learn to quilt:

Number of children:

 From class  From home extension agent  From friend  From relative  From guild or club member  From TV show

 Under 10 years of age When learned to quilt:  Age 11-19  Age 20-29

 Age 30-39  Age 40-49  Age 50 or over

 Church Why does/did the quiltmaker quilt:  Fundraising  Gifts

 Income  Necessity  Pleasure

Estimated number of quilts made by this quilter: ○ 1-5 quilts Does/did quiltmaker sell quilts: ○ yes Does/did quiltmaker teach quilting:

○ no ○ yes

 From 4-H extension agent  Self-taught  Other

 After an illness  After raising children  After retiring

 Therapy Other, why the quiltmaker quilts: ○ 5-20 quilts

○ 20-50 quilts

○ more than 50

If yes, price charged: ○ no

○ only informally

Does (did) the quiltmaker belong to a group (other than the one listed in the maker section)? Name of group: Location of group: Specialized activities/events of quilting group: Relate other stories about the quiltmaker:

The Quilt Index: http://www.quiltindex.org/

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The Quilts and Health Documentation Form ○ choose only one  choose as many as apply

Physical description of the Quilt What type of quilt is it? ○ Finished quilt ○ Quilt top with unfinished edge ○ Quilt blocks or pieces

○ Quilted garment ○ Summer spread Other type of quilt object:

Overall width measurement: Shape of edge:

○ Straight

Overall length measurement:

○ Scalloped

○ Sawtooth

○ Rounded ○ T-cutout ○ Embellished or trimmed

Other shape of edge:  Beige or Tan  Brown  Fuchsia  Green Predominate color(s):  Black  Burgundy  Gold  Lavender  Blue  Cream  Gray  Maroon

Quilt-specific colors:

 Bubblegum Pink  Butterscotch  Cadet Blue  Cheddar Orange or Antimony or Chrome Orange  Chocolate Brown or Hershey Brown  Chrome Green

 Navy  Orange  Pink

 Chrome Yellow  Claret or Wine  Double Pink  Indigo Blue  Lancaster Blue  Madder Brown

 Purple  Turquoise or Teal  Red  White  Rust  Yellow  Madder Red or Cinnamon Red  Madder Orange  Manganese Bronze  Nile Green  Prussian Blue or Lafayette Blue  Turkey Red

Other color: Overall color scheme: Overall condition:

 Multi color  Two color  One color/monochromatic  Light or pastel colors

 Bright or primary colors  Dark colors

○ Excellent/like new ○ Very good/almost new ○ Good/moderate use

○ Fair/worn

○ Poor/very worn

Notes on condition or repairs: Type(s) of inscription:  Signature Other type(s) or inscription: Content of inscription(s):

 Single

 Attached label  Embroidery Other method of inscription: Location of inscription:  multiple locations Method of inscription:

 Multiple names

 Ink  Pencil  on back

 Initials  Date

 In the quilting  Stamped  on block

 Place  Message

 Stencil  Typewriter

 on border

 Other

 Printed in the fabric  Computer generated

 other

Quilt top Layout format:

○ Block pattern ○ One patch or allover ○ Crazy

Number of quilt blocks:

○ Medallion or framed center ○ Wholecloth ○ Vertical strip

Size of quilt blocks (L x W):

Arrangement of quilt blocks: block orientation: ○ Straight ○ On point, rotated 45 degrees

○ Other

Medallion size:

○ Rotated, but less than 45 degrees

Describe the spacing relative to other blocks:  Side by side  Alternating with plain squares  Separated by plain sashing  Separated by sashing with cornerstones or connecting blocks  Separated by pieced pattern sashing  Separated by appliqued pattern sashing Other spacing:

The Quilt Index: http://www.quiltindex.org/

○ Horizontal strip ○ Pictorial ○ Nontraditional or art

 Separated by garden maze sashing  Separated by vertical strips  Separated by horizontal strips  Separated by floated or random sashing  Zig zag Sashing width:

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The Quilts and Health Documentation Form  Diamonds Block style:  Hexagons

○ choose only one  choose as many as apply Number of different block patterns present:  Same block throughout  Squares  Sampler  Triangles

Number of borders:

Border Description:

Fiber types used in quilt top:

 Cotton  Linen  Cotton or polyester blend  Polyester

Fabric types used in quilt top:

 Broadcloth  Chintz

Fabric patterns, styles, motifs, or print categories used in quilt top:

 Flannel  Feedsack

 Rayon  Silk

 Glazed  Handwoven

 Batiks  Cheater fabric  Checked  Conversation prints  Dotted  Feedsack  Floral  Geometric

 Wool  Other blends

 Linsey-woolsey  Muslin

 Hand-dyed  Mourning prints  Multiple scrap  Novelty  Paisley  Plaid  Premium type  Print

 Other synthetic  Unknown

 Sateen  Satin

 Velvet  Unknown

 Printed patchwork  Solid/plain  Stamped  Striped  Unknown Other

Construction techniques used in quilt top: piecing techniques:  Hand Piecing  English Template Piecing  Strip/String Piecing  Machine Piecing  Foundation Piecing  Other piecing Construction techniques used in quilt top: applique techniques:  Hand Applique  Fusible Applique  Blanket, buttonhole, or other decorative applique stitch  Machine Applique  Reverse Applique  Other applique Construction techniques used in quilt top: novelty techniques:  Biscuits  Dimensional applique  Cathedral Window  Folding

 Gathering/ruching  Yo-yo

Construction techniques used in quilt top: embellishment techniques:  Attachments (beading, charms, buttons, etc.)  Ink drawing  Embroidery  Painting

 Other novelty technique

 Photography/photo transfer  Other embellishment technique

Unique or other construction techniques: Embellishment materials used in top:  Beads attached  Chenille thread  Buttons attached  Cotton thread  Charms attached  Metallic thread

 Ribbon thread  Silk thread  Synthetic thread

 Wool thread Unique embellishments:  Cannot tell  Other attachments

Quilt back Fabric fiber types used in quilt back:  Cotton  Flannel  Cotton or polyester blend  Linen

 Satin/Sateen  Synthetic  Woven or homespun  Silk  Wool

 Beige or Tan  Brown  Fuchsia  Green  Navy  Black  Burgundy  Gold  Lavender  Orange  Blue  Cream  Gray  Maroon  Pink Number of pieces in quilt back: Width of pieces: Color of backing:

Description of back:  Back art/design on quilt back  Different fabrics  Hand sewn

 Machine sewn  Print  Reversible

The Quilt Index: http://www.quiltindex.org/

Other

 Purple  Turquoise or Teal  Red  White  Rust  Yellow

 Same fabric used throughout  Solid/plain

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The Quilts and Health Documentation Form ○ choose only one  choose as many as apply Quilt binding Materials used in quilt binding:  Cotton  Cotton or polyester blend

 Linen

 Silk

 Plain weave  Twill weave

 Flannel  Knit

 Satin  Sateen

Fabric structure used in binding:

Construction techniques used in binding:  Separate binding applied  Front turned to back  Back turned to front  Edges turned in/no separate binding Width of binding:

 Unfinished/raw edge  Bias grain  Straight grain  Woven tape

○ less than a half inch

 Wool  Velvet Other  Unknown

 Home cut  Hand sewn  Machine sewn  Commercial

○ half inch - one inch

 Cording  Fringe  Lace  Prairie points

○ greater than one inch

 Ribbon  Ruffles  Other

Other:

Quilt batting and quilting Material used for quilt batting or filling: ○ Cotton ○ Polyester ○ Cotton or polyester blend ○ Wool Batting loft:

○ Thin

○ Medium

○ Blanket or flannel ○ Sheet

○ Another quilt ○ No filling

○ Cannot tell ○ Other

○ Thick

Unique or other batting: Quilting techniques used:

 Hand quilting  Machine quilting

 Quilt as you go  Tied or tufted

Thread type: Number of quilting stitches per inch (Place 1): Width between quilting lines (in inches): Quilting designs used:  All-over-design  Meander/free motion  Stipple  Clamshell  Echo

 Elbow/fan  Feathering  Wreaths  Grid/crosshatch  Grid diamond

 Stuffed work  Corded

 Not quilted Other

Thread color: (Place 2): Knots visible:

○ yes

 In-the-ditch  Outline  Patches outlined/in the ditch  Cables  Floral

○ no  Vines  Parallel lines  Single parallel lines  Double parallel lines  Triple parallel lines

Other quilting designs used:

Any other features or notes about the quilt’s appearance, materials, or construction:

The Quilt Index: http://www.quiltindex.org/

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The Quilts and Health Documentation Form ○ choose only one  choose as many as apply Quilt design and materials sources  Purchased new  Sewing scraps Other source(s) of quilt’s materials: Source of quilt’s materials:

Quilt top pattern source:  Another quilt  Book  Magazine  Newspaper  Pattern

 Feed or flour sacks  Old clothes

 Kit  Computer software  Original to maker  Provided in class  Public domain/traditional pattern

 Traded for  Other quilts

 Unknown  Other

 Round robin exchange  Traditional pattern variation  Unknown  Other

Other top pattern source(s): Commercial source name(s): Exhibitions entered (list all):

Contests entered (list all):

Other related items such as publications, image, oral history, ephemera, web url, YouTube, social media, etc.:

The Quilt Index: http://www.quiltindex.org/

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The Quilts and Health Documentation Form ○ choose only one  choose as many as apply

Consent Form Person filling out form is:  Quilt owner  Relative of quiltmaker  Quiltmaker  Author/researcher

 Dealer/appraiser  Friend of quiltmaker

 Quilt collector  Quilting teacher

 Unknown

Other: Ownership of this quilt is: ○ Private

○ Public

○ Public Museum, Library or Institution

Name of quilt owner: Quilt owner street address:

Quilt owner city:

Quilt owner county:

Quilt owner reservation:

Quilt owner state:

Quilt owner province:

Quilt owner zip/postal code:

Quilt owner country:

Quilt owner phone number:

How was quilt acquired by owner:

○ Gift ○ Inheritance

○ Made by owner ○ Presentation/award

○ Purchase ○ Raffle or contest prize

○ Unknown ○ Other

Occasion, date, person inherited from, etc.: Any additional stories or notes about the quilt’s ownership or history:

Image Inventory Content of image Quilt Maker Detail 1 Detail 2 Detail 3 Detail 4

Image file name (.jpg)

Access and copyright information for image:

Photographer/photo credit

○ Open/Public Domain

Date image taken

○ Restricted

For holder of copyright, contact:

I release to the Quilt Index the information recorded on this form, the photos provided with this form, and the related photos taken by the Quilt Index for the educational and research purposes they deem appropriate. Name:

Date:

May the staff of the Quilt Index contact you about this quilt?  Yes, contact maker

 Yes, contact:

 Yes, contact owner  No

Contact’s email address: Return with images to: The Quilt Index, 570 Red Cedar Rd. #103, East Lansing, MI 48824 or [email protected] For office use only:

The Quilt Index: http://www.quiltindex.org/

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