NPS National Underground Railroad Network to Freedom App

OMB Control No. 1024-0232

Expires: XX/XX/2016

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 Boundaries of Site/facility:

___ Address not for publication?

Date Submitted:

Is there a website? Yes___ No____ Address:

Is there a visitor phone number? Yes___ No__ Phone number:

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: The authority to collect this information is the National Underground Railroad Network to Freedom Act (P.L. 105-203). We will use this information to evaluate properties, facilities, and programs nominated for inclusion in the Network to Freedom. We may not conduct or sponsor and you are not required to respond to a collection of information unless it displays a currently valid OMB control number. Your response is required to obtain or retain a benefit.

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 Information Collection Clearance Officer, National Park Service, 1201 I Street, MS 1237, Washington, DC 20005.

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

All attachments supplement, but do not replace the text.

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)

___ 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 ___ Legal challenge ___ Escape

___ Rescue ___ Kidnapping ___ Maroon community ___ Destination

___ Church ___ Cemetery ___ Military site ___ Transportation route

___ Commemorative site/monument ____historic district/neighborhood

___ Archeological site ___ Other (describe)

S4. Describe the site’s association and significance to the Underground Railroad. Provide citations for sources used throughout the text. Timelines are encouraged.

S5. Provide a history of the site since its time of significance to the Underground Railroad, including physical changes, changes in boundaries over time, archeological work, or changes in ownership or use. Be sure to describe what is included in the present application and how that compares to what the site was historically.

S6. Include a bibliography or list of citations for sources used through the document. Discuss the reliability of historical sources of information and briefly discuss how you used them.

S7. Describe current educational programs, tours, markers, signs, brochures, site bulletins, or plaques at the site. Include text and photographs of markers.

S8. Describe any local, State, or Federal historic designation, records, signage, or plaques at the site.

S9a. Is the site open to the public? Yes___ No___ Hours:

S9b If open, describe accessibility conditions under the Americans with Disabilities Act.

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) These brochures and excerpts from sources do not replace the required narrative.

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 under the Americans with Disabilities Act. Describe what personal assistance visiting researchers receive.

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 ___Tour ___Performance ___ Living history

___Exhibit ___Website ___Curriculum-based education ___Youth program

____Other (describe):

P2. What do you want your audience to know about the Underground Railroad, 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 where the program has been presented.

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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