Form 10-946 NPS National Underground Railroad Network to Freedom App

NPS Fonn 10-946 (Rev. 09/2019)
National Park Service

0MB Control No. 1024-0232
Expiration Date XX/XX/20XX

NATIONAL UNDERGROUND RAILROAD
NETWORK TO FREEDOM APPLICATION

Date Submitted:

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Resubmission:
Yes D No

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Name (Of What You Are Nominating):
City:

State:

NATIOW.L
UNDER.GROUND RAILROAD
NETWORK TO FREEDOM

GENERAL INFORMATION
Type (Pick One):

Round:

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□

Site

□

Facility D Program

Street Address:
Zip Code:

Physical Boundaries of Site/Facility

County:

Congressional District:

D Address Not for Publication?

ls there a website?
D Yes D No

Web Address:

ls there a visitor phone number?
D Yes D 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 certify that thi5 D site

D facility D program i5 included in the Network to Freedom.

Signature of Certifying Official/Title

Date

RECORDS RETENTION: PERMANENT. Transfer permanent special media, and electronic records along with any finding aids or
descriptive information (including linkage to the original file) and related documentation by calendar year to the National Archives
when 3 years old. (Item ?A.2.) (N1-79-08-6))

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NPS Fonn 10-946 (Rev. 09/2019)
National Park Service

0MB Control No. 1024-0232
Expiration Date 0X/XX/20XX

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Contact information for D Owner/Manager D Application Preparer (Share Contact Information
Name:
Street Address:

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Phone:

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City

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□ Yes

Fax:

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Contact information for D Owner/Manager D Application Preparer (Share Contact Information D Yes
Name:

Phone:

Fax:

0 No)
Email:

□ No)
Email:

City

Street Address:

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Contact information for D Owner/Manager D Application Preparer (Share Contact Information D Yes
Name:

Phone:

Fax:

□ No)

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Contact information for D Owner/Manager D Application Preparer (Share Contact Information D Yes
Name:

Phone:

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Contact information for D Owner/Manager D Application Preparer (Share Contact Information D Yes
Name:
Street Address:

□ No)
Email:

City

Street Address:

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Fax:

Phone:

Fax:

City

State:

State:

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Zip Code

Zip Code

Email:

City

Street Address:

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□ No)
Email:

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State:

State:

State:

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Zip Code

Zip Code

Zip Code

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 sunnlement, but do not reolace the text.
D Object
D District (Neighborhood)
D Landscape/Natural Feature
D Structure
D Archeological Site
D Other (Describe):
lf yes, what is the listing name?
S2. Is the site listed in the National
Yes
Register of Historic Places?
0 No

0 Building

S1. Type:

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D Private D Private, Non-profit (501c3) D Public - Local Government
D Public - State Government D Public - Federal Government
S4. Type(s) of Underground Railroad Association (select the one(s) that fit best):
D Station
D Kidnapping
D Legal Challenge
D Association with Prominent Person
S3. Ownership of site:

D Escape

D Rescue

D Maroon Community

D Historic DistricUNeighborhood

D Church

D Destination

D Transportation Route

D Commemorative Site/Monument

D Cemetery

0 Military Site

D Archeological Site

D Other (Describe):

S4a. Describe the site's association and significance to the Underground Railroad. Provide citations for sources used throughout the text. Timelines
are encouraged.

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NPS Form 10-946 (Rev. 09/2019)
National Park Service

0MB Control No. 1024-0232
Expiration Date 0X/XX/20XX

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.

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

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

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

S9a. Is the site open to the public? D Yes D No

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Days and Hours of Operation:

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.

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NPS Fonn 10-946 (Rev. 09/2019)
National Park Service

0MB Control No. 1024-0232
Expiration Date XX/XX/20XX

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:

D Archive

D Library

D Research Center

D 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.

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NPS Fonn 10-946 (Rev. 09/2019)
National Park Service

0MB Control No. 1024-0232
Expiration Date XX/XX/20XX

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.

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NPS Form 10-946 (Rev. 09/2019)
National Park Service
P1. Type:

D Public Program

□ Exhibit

0MB Control No. 1024-0232
Expiration Date XX/XX/20XX

□ Tour
□ Website

D Performance
D Curriculum-based Education

D Living
D Youth Program

D 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.

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

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

P?. Describe where the program has been presented.

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

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NPS Form 10-946 (Rev. 09/2019)
National Park Service

0MB Control No. 1024-0232
Expiration Date XX/XX/20XX

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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NPS Form 10-946 (Rev. 09/2019)
National Park Service

0MB Control No. 1024-0232
Expiration Date XX/XX/20XX

NOTICES
Privacy Act Statement
General: This information is provided pursuant to Public Law 93-579 (Privacy Act of 1974), December 21, 1984, for individuals
completing this form.
Authority: National Underground Railroad Network to Freedom Act (P.L. 105-203).
Purpose and Uses: 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 Vv'ho are researching related topics, historic events, or individuals or
who may have technical expertise or resources to assist vvith 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 vvilling
to be contacted by others VvOrking 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. The DOI and NPS may
use the information to meet reporting requirements, to generate budget estimates and track performance, and to assist park staff vvith
visitors' education, fee collection, resource management and protection, recreational use planning, law enforcement and public safety
personnel for such purposes as emergency contact and search and rescue efforts; to provide permit holders and participants with
information about parks and their partners; and to provide reports of activities conducted under an issued permit.
Disclosure: Voluntary. However, failure to provide the requested information may impede our ability to process your application. It is in
your best interest to answer all of the questions. The U.S. Criminal Code, Title 18 U.S.C. 1001, provides that knovvngly falsifying or
concealing a material fact is a felony that may result in fines of up to $10,000 or 5 years in prison, or both. Deliberately and materially
making false or fraudulent statements on this form will be grounds for not approving your application.
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 0MB control number.
Your response is required to obtain or retain a benefit. 0MB has approved this collection of information and assigned control number
1024-0232.
Estimated Burden Statement
Public reporting for this collection of information is estimated to average 40 hours per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection
of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to the Information Collection Officer, National Park Service, 1201 Oakridge Drive, Fort Collins, CO
80525. Please do not send your completed application to this address.

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