Form CAP Application Fo CAP Application Fo CAP Application

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Program Application

Table of Contents

Application Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Application Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Supplement A: For Museums and Historic Sites. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Supplement B: For Arboreta and Botanical Gardens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Supplement C: For Zoos and Aquariums. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

1. Application Guidelines

Thank you for your interest in the CAP Program! Please answer all of the questions in this application to the best of your ability.

Glossary

To assist in all steps of the CAP Program, a CAP Glossary can be found on the FAIC website at www.conservation-us.org/CAPglossary. Throughout the application, look for the (^) symbol, which indicates more information about a term can be found in the CAP Glossary.

Supplements

Please complete one of the three Application Supplements based on your institution type. Choose the category that best describes your institution.

Select Supplement A if your institution is a museum or historic site.

Select Supplement B if your institution is an arboretum or botanical garden.

Select Supplement C if your institution is a zoo or aquarium.

Notification of Receipt

Institutions will be notified via email when their application has been received and if any additional information is needed. If you have not received an email within 72 hours of submission, contact the CAP office at 202-750-3437 or [email protected] to make sure we have received your application.

Application

1. General Information

Applicant institution: ___________________________________________________________

Applicant parent institution (if applicable): __________________________________________

Institutional mailing address: _____________________________________________________

City: _________________________ County: _________________________________

State: ____________ Zip: ___________

Website: _____________________________________________________________________

EIN/TIN^ number: ________________________

Project Contact (The project contact should be the person who will administer the CAP Program for the institution. All CAP correspondence will be directed to this person.)

 Mr.  Ms.  Miss  Mrs.  Dr.  Prof.  Rev

Name: _____________________________________________________________________

Title: ______________________________________________________________________

Phone: ________________________________ E-mail: ______________________________

If open seasonally, provide a phone number to reach staff in the off-season:

___________________________________________________________

Governing Control of Applicant (check one)

 state  county  municipal  private

 nonprofit  university  tribal government  other, specify: __________

Type of Organization (check one)

 Aquarium

 Arboretum/Botanical Garden

 Art Museum

 Children’s/Youth Museum

 General Museum (A museum with collections representing two or more disciplines equally, such as a museum of art and natural history.)

 Historic House/Site

 History Museum

 Natural History Museum/ Anthropology Museum

 Nature Center

 Planetarium

 Science/ Technology Museum

 Sculpture Park

 Specialized Museum (A museum with collections limited to one narrowly defined discipline, such as a maritime museum.)

 Zoological park

 Other (please specify: _______________________________________)

Does your institution have a parent organization?

 Yes  No

If yes, what is the name of the parent organization? ______________________________

What is your institution’s mission statement?

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

In what year was the institution first open to the public? ____________________________

Does your organization exist on a permanent basis for educational or aesthetic purposes?

 Yes  No

Does your institution own tangible objects, whether animate or inanimate?

 Yes  No

Are these objects available to the public through exhibition and/or research on a regular basis?

 Yes  No

Does your institution have at least one full-time paid or unpaid staff member or the equivalent combination of part-time staff, whose responsibilities relate solely to the institution’s activities?

 Yes  No

Can assessors review the entire collection and buildings within a two-day site visit? (consider all buildings that house collections, including any off-site storage)

 Yes  No

2. General Operating Budget

What was your institution’s approximate operating budget for the most recently completed operating year: $___________________

3. Staff

Number of paid staff:

Full-time __________

Part-time _________

Number of non-paid staff:

Full-time __________

Part-time __________

List the key staff (paid and volunteer) who work with collections and exhibitions, along with their average hours per week. Since job titles vary among institutions, please briefly explain each staff member’s responsibilities.

Name: Title:

 Volunteer or  Paid

Hours per week: ____________

Responsibilities: ____________________________________________________________

Name: Title:

 Volunteer or  Paid

Hours per week: ____________

Responsibilities: ____________________________________________________________

Name: Title:

 Volunteer or  Paid

Hours per week: ____________

Responsibilities: ____________________________________________________________

Name: Title:

 Volunteer or  Paid

Hours per week: ____________

Responsibilities: ______________________________________________________________

Name: Title:

 Volunteer or  Paid

Hours per week: ____

Responsibilities: ______________________________________________________________

Name: Title:

 Volunteer or  Paid

Hours per week: ____________

Responsibilities: ________________________________________________________________

(Attach a list of additional relevant staff if necessary.)

4. Goals

What goals does the organization have for this assessment? (Check all that apply.)

 Develop a long-range preservation/conservation plan^ for collections

 Improve collections care^

 Increase staff and board awareness of collections conservation^ concerns

 Improve the preservation^ of the building

 Improve environmental conditions

 Improve storage conditions

 Use as a tool to obtain funding for collections care

 Prepare for accreditation

 Other: ______________________________________________________________

Comments/special concerns: ________________________________________________

________________________________________________________________________

5. Site Information

Site area:

 less than 1 acre

 1-5 acres

 6-10 acres

 more than 10 acres

How many buildings hold collections storage or exhibitions? _____________________________

Are they all on the same site?  Yes  No

If no, where are the buildings located? ____________________________________________________________________________________________________________________________________________________________

Does your organization own all of the land and buildings it occupies?  Yes  No

If no, please explain.

___________________________________________________________________________________________________________________________________________________________

6. Building Information

Complete the following section for each structure that houses collections storage or exhibition space. Attach additional pages if necessary.

Building #1

Building name: ________________________________________________________________

Number of stories: __________

Approximate square footage or dimensions: _____________

Type of structure:

 modern building built as a museum or collections space

 older building (50 years or older) built as a museum or collections space

 older or historic structure not originally designed as a museum or collections space

 building shared with other non-museum activities

 other: ______________________________________________________

Approximate construction date: __________________

Does the building have additions?  Yes  No

If yes, please list approximate construction date(s) of the additions: ___________________

This structure is used for (check all that apply):

 collections

 storage

 exhibits (with artifacts)

 office space

 other: ______________________________________________________

Please use this space to share any additional information you would like to share about Building #1 (optional).

Building #2 (if applicable)

Building name: ________________________________________________________________

Number of stories: __________

Approximate square footage or dimensions: _____________

Type of structure:

 modern building built as a museum or collections space

 older building (50 years or older) built as a museum or collections space

 older or historic structure not originally designed as a museum or collections space

 building shared with other non-museum activities  other: ______________________________________________________

Approximate construction date: __________________

Does the building have additions?  Yes  No

If yes, please list approximate construction date(s) of the additions: ___________________

This structure is used for (check all that apply):

 collections

 storage

 exhibits (with artifacts)

 office space

 other: ______________________________________________________

Please use this space to share any additional information you would like to share about Building #2 (optional).

Building #3 (if applicable)

Building name: ________________________________________________________________

Number of stories: __________

Approximate square footage or dimensions: _____________

Type of structure:

 modern building built as a museum or collections space

 older building (50 years or older) built as a museum or collections space

 older or historic structure not originally designed as a museum or collections space

 building shared with other non-museum activities  other: ______________________________________________________

Approximate construction date: __________________

Does the building have additions?  Yes  No

If yes, please list approximate construction date(s) of the additions: ___________________

This structure is used for (check all that apply):

 collections

 storage

 exhibits (with artifacts)

 office space

 other: ______________________________________________________

Please use this space to share any additional information you would like to share about Building #3 (optional).

If your site contains more than three structures that house collections, please upload a document that lists all additional structures. Please include all information requested above for each structure.

7. Additional Information

Are funds regularly expended on collections conservation at your institution?  Yes  No

If yes, how does your institution allocate funds for conservation (check all that apply):

 Collections conservation is an item in our annual budget

 Funds are allocated in response to a need

 Funds are sought through grants or donations in response to a need

 Other: ______________________________

For the following questions, attach additional pages as needed.

Explain the significance of your organization’s collections and how they are used. (Please limit your response to no more than 500 words.)

What are your biggest concerns regarding the collection? (Please limit your response to no more than 500 words.)

How does this proposed assessment fit into the institution’s overall preservation goals? (Please limit your response to no more than 500 words.)

8. Proof of nonprofit or government status

• Nonprofit organizations

Submit a copy of the federal IRS letter indicating the institution’s eligibility for nonprofit status under the application provisions of the Internal Revenue Code of 1954, as amended.

NOTE: If the name or TIN on the IRS letter differs from the applicant institution because the IRS letter of a parent organization is being used (as with a university museum), submit a letter explaining the relationship between the two organizations on the parent organization’s letterhead and signed by an official at the parent organization (for example, a provost). This letter must be submitted in addition to the IRS letter of the parent organization.

• Institutions that are a unit of local, state, or tribal government:

Submit a letter identifying the institution as a unit of government on that government entity’s letterhead and signed by an official at that unit of government.

FAIC will not accept a letter of sales tax exemption or a copy of the institution’s tax returns as proof of nonprofit status.

9. Certification

Participants in the Collections Assessment for Preservation program must obtain the approval of their board or governing body before applying to the program. To demonstrate this approval, please designate a board or governing body official who will serve as the Authorizing Official. The Authorizing Official should be an executive member of the organization’s governing body, the head of the sponsoring organization, or the government official responsible for oversight of the institution.

When the application is complete, the Authorizing Official must complete the information below. In the event that FAIC staff is unable to reach the institution’s staff for questions about the CAP application or the organization’s participation in the program, the Authorizing Official listed below may be contacted.

Statement of Authorizing Official:

I am a member of the Board of Directors or Governing Body, or the Government Official responsible for oversight of the organization, and am authorized to submit this application to the Collections Assessment for Preservation program. I certify that all of the information contained in this application is true and accurate to the best of my knowledge. Should our organization be chosen to participate in the program, our staff will be responsible for complying with all requirements and guidelines of the Collections Assessment for Preservation program, including:

• participating in the CAP program orientation

• selecting and contracting assessor(s)

• completing Site Questionnaire

• facilitating and participating in a pre-visit phone call with assessor(s)

• facilitating assessors’ site visit

• reviewing CAP report draft

• completing program evaluations

• facilitating a one-year follow-up call or videoconference with assessor(s)

Signature of Authorizing Official: ______________________________ Date: _____________ Mr.  Ms.  Dr.

Name: ____________________________________ Title: _______________________________

Phone: ___________________________ E-mail: ______________________________________

Supplement A: For Museums and Historic Sites

Is a significant portion of the collection held on loan, or owned by another institution?

 Yes  No

If no, please explain: ______________________________________________________

Please share the approximate size and composition of your collection by placing an “x” in the appropriate column for each collection type in the chart below. Exact numbers are not expected. Please estimate to the best of your ability.

Collection type Number of Objects

	0	1 - 100	101 - 1,000	1,001 -10,000	10,001+
Archaeological/paleontological artifacts
Arms and armor/weapons
Botany (live)
Botany (herbaria)
Ceramics and glass
Digital (born-digital)
Ethnographic artifacts
Furniture
Geology/mineralogy
Historic objects
Industrial/agricultural tools and equipment
Leather/animal hides
Library/books/archival materials
Metal objects
Musical instruments
Paintings
Photographic materials
Science/technology/medicinal artifacts
Sculpture
Stone objects
Taxidermy
Textiles and costume
Time based media (film, audio recordings, etc.)
Transportation vehicles
Works on paper
Wet collections/fluid preserved collections
Wood objects
Zoology (live)
Zoology (preserved)
Other (specify:)

Total number of objects in the collection (please estimate if exact numbers are unavailable): ____________

Supplement B: For Arboreta and Botanical Gardens

1. Collections and Collection Records

In order to best match an institution with conservators, we ask that you share the approximate size and composition of your collection by answering the questions below. Exact numbers are not expected. Please estimate to the best of your ability.

Approximately how many different living plant specimens does the institution maintain? ___________

Approximately how many herbarium^ specimens does the institution maintain? ___________

What is the size and composition of the institution’s collections? (check one box for each row)

	0	1 - 100	101 - 1,000	1,001 +
Woody
Non-woody
Hardy at site
Not hardy
Annual/Seasonal

Are there non-living collections that you wish to have assessed?

 Yes  No

If yes, please share the approximate size and composition of your collection by placing an “x” in the appropriate column for each collection type in the chart below. Exact numbers are not expected. Please estimate to the best of your ability.

Collection type Number of Objects

	0	1 - 100	101 - 1,000	1,001 – 10,000	10,001+
Archaeological/paleontological artifacts
Arms and armor/weapons
Ceramics and glass
Digital (born-digital)
Ethnographic artifacts
Furniture
Geology/mineralogy
Historic objects
Industrial/agricultural tools and equipment
Leather/animal hides
Library/books/archival materials
Metal objects
Musical instruments
Paintings
Photographic materials
Science/technology/medicinal objects
Sculpture
Stone objects
Taxidermy
Textiles and costume
Time-based media (film, audio recordings, etc.)
Transportation vehicles
Works on paper
Wet collections/fluid preserved collections
Wood objects
Zoology (live)
Zoology (preserved)
Other (specify:)

Total number of objects in the collection (please estimate if exact numbers are unavailable): ____________

2. Facilities Information

Approximately what percentage of the land is used for:

Cultivated collections? ____ %

Natural areas? ____ %

Visitor services (restrooms, food and beverage services, picnic or recreation areas, parking lots, etc.)?

Administration and maintenance? ____%

other: ____ %

Supplement C: For Zoos and Aquariums

1. General Information

Is the institution accredited by the Association of Zoos and Aquariums?  Yes  No

If yes, date: ____________________

Institutions that are AZA accredited may receive an assessment of facilities and any non-living collections through the CAP Program. Institutions that are not AZA accredited may receive an assessment of their living collections and facilities.

2. Collections and Collection Records

Describe the size and range of your collections by listing the approximate number of species and specimen in your collection for each group. Please estimate to the best of your ability.

	Number of Species	Number of Specimen
Birds
Fish
Invertebrates
Mammals
Reptiles and Amphibians
Other (specify)

Are there non-living collections that the institution wishes to have assessed?

 Yes  No

If yes, please share the approximate size and composition of your collection by placing an “x” in the appropriate column for each collection type in the chart below. Exact numbers are not expected. Please estimate to the best of your ability.

Collection type Number of Objects

	0	1 - 100	101 - 1,000	1,001 -10,000	10,001+
Archaeological/paleontological artifacts
Arms and armor/weapons
Botany (live)
Botany (herbaria)
Ceramics and glass
Digital (born-digital)
Ethnographic artifacts
Furniture
Geology/mineralogy
Historic objects
Industrial/agricultural tools and equipment
Leather/animal hides
Library/books/archival materials
Metal objects
Musical instruments
Paintings
Photographic materials
Science/technology/medicinal artifacts
Sculpture
Stone objects
Taxidermy
Textiles and costume
Time based media (film, audio recordings, etc.)
Transportation vehicles
Works on paper
Wet collections/fluid preserved collections
Wood objects
Zoology (preserved)
Other (specify:)

Total number of objects in the collection (please estimate if exact numbers are unavailable): ____________

3. Facilities Information

Approximately what percentage of the land is used for:

Animal habitats? ____ %

Natural areas? ____ %

Visitor services (restrooms, food and beverage services, picnic or recreation areas, parking lots, etc.)? ____%

Administration and maintenance? _____%

Other? ____ %

OMB Number: 3137-0103 Expiration Date: 7/31/2018 IMLS-CLR-F-0045