Required Concealed Data

AIA Central States Excellence in Design Program

Entry Number: _______

Entry Verification

Entry Name:

Address:

County:

City:

State/Zip:

Completion Date or Unbuilt Category/Commissioned Date if applicable:

Architect or Firm

Name:

Firm:

Address:

City:

State/Zip:

Telephone:	E-Mail:

Name and City sufficient for the following:

Consultant(s):

Architect of Record:

Additional Consultants:

General Contractor:

Photographer (one per entry):

Architecture Students:

Please note any submissions that include student involvement must be identified and recognized as a collaborative partner on visual and data submissions. Indicate if students are volunteers or paid for their contributions.

Owner(s):

Individual Name and or Company Name:

(for printed materials including Excellence in Design Award(s) + Omaha World Herald Architecture Supplement.

Telephone:

E-Mail:

Address:

City:

State/Zip:

County:

Certification

By placing this Entry on the AIA NE Dropbox, the entrant agrees the information contained in this Entry submission and on this “Concealed Identification” form is correct and complete, and that the entrant will hold harmless AIA Central States Region for any and all damages arising out of its use of the information on this form and in this Entry submittal. Any and all errors or omissions are the responsibility of the entrant. Each entrant further certifies that permission has been obtained from the owner and photographer to publish the photographs submitted and all information submitted and to take further photographs and obtain further information about the above listed project and releases and each entrant authorizes the AIA Central States Region reserves the right to use entry submissions for educational programs, people’s choice award program and in future promotion of the awards progression and the profession. Entrants further acknowledge the Jury decisions will be final based on verification of compliance to submittal requirements.