NPS National Underground Railroad Network to Freedom App

OMB Control No. 1024-0232

National Park Service

National Underground Railroad Network to Freedom

GENERAL INFORMATION

Type (pick one): ___ Site ___ Facility ___ Program

Name (of what you are nominating):

Address:

City, State, Zip:

County: Congressional District:

Physical Location of Site/facility (if different):

___ Address not for publication?

Date Submitted:

Summary: Tell us in 200 words or less what is being nominated and how it is connected to the Underground Railroad.

FOR NATIONAL PARK SERVICE USE ONLY

I hereby certify that this ___ site ___ facility ___ program is included in the Network to Freedom.

__________________________________ _________________

Signature of certifying official/Title Date

Owner/Manager (Share contact information ___Y ___ N)

Name:

Address:

City, State, Zip:

Phone: Fax: E-mail:

Owner/Manager (Share contact information ___Y ___ N)

Name:

Address:

City, State, Zip:

Phone: Fax: E-mail:

Owner/Manager (Share contact information___Y ___ N)

Name:

Address:

City, State, Zip:

Phone: Fax: E-mail:

Application Preparer (Enter only if different from contact above.) (Share contact information ___Y ___ N)

Name:

Address:

City, State, Zip:

Phone: Fax: E-mail:

Privacy Information: The Network to Freedom was established, in part, to facilitate sharing of information among those interested in the Underground Railroad. Putting people in contact with others who are researching related topics, historic events, or individuals or who may have technical expertise or resources to assist with projects is one of the most effective means of advancing Underground Railroad commemoration and preservation. Privacy laws designed to protect individual contact information (i.e., home or personal addresses, telephone numbers, fax numbers, or e-mail addresses), may prevent NPS from making these connections. If you are willing to be contacted by others working on Underground Railroad activities and to receive mailings about Underground Railroad-related events, please add a statement to your letter of consent indicating what information you are willing to share.

Paperwork Reduction Act Statement: This information is being collected for applications to the National Park Service’s National Underground Railroad Network to Freedom to nominate properties, facilities, and programs to the Network to Freedom. A Federal agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Response to this request is required for inclusion in the Network to Freedom in accordance with the National Underground Railroad Network to Freedom Act (P.L. 105-203).

Estimated Burden Statement: Public reporting burden for this form is estimated to average 25 hours per response including time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding this burden estimate or any aspect of this form to the National Coordinator, National Underground Railroad Network to Freedom, NPS, 601 Riverfront Drive, Omaha, Nebraska 68102.

SITES:

In addition to the responses to each question, applications must also include the following attachments:

1. Letters of consent from all property owners for inclusion in the Network to Freedom (see sample in instructions)

2. Text and photographs of all site markers

3. Original photographs illustrating the current appearance and condition of the site being nominated

4. Maps showing the location of the site

S1. Type:

___ Building ___ Object ___ District (neighborhood)

___ Structure ___ Landscape/natural feature ___ Archeological site

___ Other (describe):

S2. Is the site listed in the National Register of Historic Places? ___Y ___ N

What is the listing name:

S3. Ownership of site:

___ Private ___ Private, non-profit (501c3) ___ Multiple ownership

___ Public, local government ___ Public, state government ___ Public, federal government

S4a. Type(s) of Underground Railroad Association (select the one(s) that fit best)

___ Station ___ Assoc. w/ prominent person ___ Rebellion site ___ Legal challenge

___ Escape ___ Rescue ___ Kidnapping ___ Maroon community

___ Destination ___ Church w/active congregation ___ Cemetery ___ Transportation route

___ Military site ___ Commemorative site/monument ____historic district/neighborhood

___ Archeological site ___ Other (describe)

S4. Describe the site’s association and significance to the Underground Railroad. Provide citations. Timelines are encouraged.

S5. Provide a history of the site since its time of significance to the Underground Railroad, including physical changes, changes in ownership or use.

S6. Describe current educational programs, tours, markers, signs, brochures, site bulletins, or plaques at the site. Include text and photographs of markers.

S7. Include a bibliography. Discuss historical sources of information and how you used them.

S8. Describe any local, state, or federal historic designation, records, signage, or plaques at the site.

S9. Is the site open to the public? Describe accessibility conditions.

S10. Describe the nature and objectives of any partnerships that have contributed to the documentation, preservation, commemoration, or interpretation of the site.

S11. Additional data or comments. (Optional)

FACILITIES

In addition to the responses to each question, applications must also include a letter of consent for inclusion in the Network to Freedom from the facility owner or manager.

F1. Type:

___ Archive ___ Library ___ Research Center

___ Other (describe):

F2. Provide a general description of the facility and its purpose or mission.

F3. Describe the holdings or collections and discuss their significance to the Underground Railroad.

F4. List the Underground Railroad or slavery-related items or materials in the facility.

F5. Describe the documents the facility has to verify the sources of its collections.

F6. Describe the indexes or finding aids that are available for the facility’s collections.

F7. Describe the facility’s management and staff, and levels of training or certifications.

F8. Describe the types of publications, reports, or services the facility performs or produces.

F9. Describe the conditions of public use at the facility, including accessibility.

F10. Describe visitation workload at the facility.

F11. Describe the facility’s traveling exhibit, interlibrary-loan, and photocopying or duplication policies and capabilities.

F12. Describe the nature and objectives of any partnerships that have contributed to the operation of the facility.

F13. Additional data or comments. (Optional)

EDUCATIONAL AND INTERPRETIVE PROGRAMS

In addition to each question, applications must also include the following attachments:

1. Letters from people consulted in the development of the interpretive program describing their input and participation in the process.

2. An example of an audience feedback card or questionnaire or other audience feedback mechanism.

3. A letter of consent for inclusion in the Network to Freedom from the owner or manager of the program.

4. A DVD or video of the program or a sample of the program for evaluation purposes. See instructions for use policy. (Optional but recommended.)

P1. Describe the program.

P1a.Type:

___Public program ___ School Program ___Tour ___Performance

___ Living history ___Exhibit

___Other (describe):

P2. What is the Underground Railroad message of your program, and how is it presented?

P3. Describe what advice you sought in developing your program.

P4. Identify historical sources of information and describe how they were used to develop the program. Include a bibliography.

P5. Describe the educational objectives of the program, tour, or performance.

P6. For whom is the program intended? Is the program fully accessible to all?

P7. Describe the geographic area of program presentation or activity.

P8. Describe how the program is evaluated and how you use the results to improve the program.

P9. How long has the program existed and what are the future plans for the program.

P10. Describe the program’s management and staff, and levels of training or certification.

P11. Describe the nature and objectives of any partnerships that have contributed to the program.

P12. Additional data or comments. (Optional)

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