![](media/image1.jpeg){width="2.0in" height="1.3333333333333333in"}

**FY 2009 *Preserve America ***

**Historic Preservation Fund Grants to Preserve and**

**Promote America's Heritage and Cultural Assets**

APPLICATION FORM

Please follow the Guidelines and Application Instructions to complete
this application. Please complete the SF424 Application for Federal
Assistance, and note that some fields have been pre-filled and should
not be changed. Applicants must submit one (1) signed original and seven
(7) copies -- a total of 8 -- complete application packages,
[plus]{.underline} one (1) additional photocopy of this page. See
additional mailing instructions on the last page of the application
form.

**1. GENERAL INFORMATION**

Project Title (10 words or less)
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

Applicant Organization
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Contact Person
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**
Title
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

Address
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

City
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**
State **\_\_\_\_\_\_\_\_\_** Zip Code
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

##  Telephone ( ) - FAX Number ( ) - E-mail \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

EIN Number: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
DUNS Number:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Applicant's Congressional District(s) \_\_\_\_\_\_\_\_\_\_\_\_\_ U.S.
Representative(s)
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Type of Applicant** (Select all that apply)

> *Preserve America* Community
>
> *Preserve America* Neighborhood
>
> SHPO
>
> THPO
>
> CLG (must be in the process of applying for *Preserve America*
> designation or already designated)

**Project Category:** (Select only [one]{.underline})
Research/Documentation Marketing Training

> Interpretation/Education Planning

**Amount Requested** Federal Share **\$** \_\_\_\_\_\_\_\_\_\_\_\_

Matching Share **\$** \_\_\_\_\_\_\_\_\_\_\_\_

Total Costs **\$** \_\_\_\_\_\_\_\_\_\_\_\_

> **Is your community in a designated National Heritage Area?**
>
> **No** **Yes** If so, which NHA
> **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**
>
> Does your community have an active grant or financial assistance
> through the NHA? **No** **Yes**
>
> **Has your community received a Preserve America grant before?**

**No** **Yes** If so, what is the status?
\_**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**SIGNATURE OF AUTHORIZING OFFICIAL** (Original copy must have an
original signature and be in ink.)

Signature
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**
Date **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

Print Name and Title

**2. PROJECT SUMMARY**

**A.** **Briefly summarize your project emphasizing the primary
objectives and results**.

(Your summary must fit in the space provided. Use at least a 10-point
font.)

**3. PROJECT DESCRIPTION AND BUDGET**

Applicants are strongly encouraged to provide answers in the spaces
provided.

A.  **Describe the historic resources affected by the project, including
    whether they are listed in the National Register of Historic Places
    and/or designated at the State or local level.** Please explain how
    this project will aid in the preservation of the resources listed.

B.  **Project Objectives**

-   **How will the proposed project promote heritage tourism in the
    community and lead to the preservation of its historic resources?**

-   **Describe how the project meets the goals of the local or statewide
    preservation plan, heritage tourism plan, or other plan(s) that
    address heritage tourism, cultural resources, and preservation.
    Identify the specific goal(s) and plan(s) and state when they were
    developed and adopted by the community.**

```{=html}
<!-- -->
```
-   **Describe the public-private partnerships involved in the project
    and how these partnerships will sustain and support the resource(s)
    after the grant project is complete?** Describe/list all entities
    that are involved with, or affected by, the project. Attach evidence
    of involvement from partner organizations such as letters of support
    that specifically state confirmation of their contribution(s). See
    Supplemental Information in the guidelines for more information
    regarding partnership documentation.

+-------------------------------------+--------------------------------+
| **PARTNER**                         | **CONTRIBUTION**               |
+-------------------------------------+--------------------------------+
| -                                   |                                |
+-------------------------------------+--------------------------------+
| -                                   |                                |
+-------------------------------------+--------------------------------+
| -                                   |                                |
+-------------------------------------+--------------------------------+
| -                                   |                                |
+-------------------------------------+--------------------------------+

-   **Explain how the project will engage public involvement?**

C.  **Project Activities \--** Describe the project activities necessary
    to achieve the Project Objectives? List and describe all tasks and
    products. All grant activities must be accomplished within the grant
    period (generally 1 to 2 years).

D.  **Timeline \--** Show a timeline for all of the above listed
    activities. The timeline may be attached as a separate page.

E.  **Personnel & Consultant Qualifications** \-- List the project
    personnel that will administer and the types of consultants that
    will be hired to complete the project. Describe their
    responsibilities and the percentage of time each will dedicate to
    the project. Describe the criteria that will be used to
    competitively select consultants for their services. ***All Federal
    grants require consultants to be competitively selected*** (please
    see page 3 of the guidelines for more information)**.**

F.  **What are the sources of the non-federal match?**

> List the **secured** sources and other funds associated with the
> required dollar-for-dollar non-Federal match, which can be cash,
> donated services, or use of equipment. Federal appropriations or other
> Federal grants may **not** be used for match, except Community
> Development Block Grants (CDBG) grants from the Department of Housing
> and Urban Development. All non-Federal matching funds must be used
> during the grant period to execute the project. If the match is **not
> secured**, explain how it will be raised.

G.  **Budget** \-- Outline the project budget in the form below; add
    additional lines in a category as needed.

-   All costs associated with the project must be eligible, reasonable,
    and directly relevant to the project.

-   Each cost item must clearly show how the total charge for that item
    was determined (example: hours x hourly rate = total cost).

-   [All major costs must be listed, and all cost items should be
    explained in the narrative of the application]{.underline}.

-   The budget must include at least the minimum required match (e.g.,
    if applying for a \$30,000 grant, the budget must describe a total
    of \$60,000 in costs/work).

-   All non-Federal match must be cash expended or services donated
    during the grant period (generally 1 to 2 years) and not before.

-   If including indirect costs, please make sure to include
    documentation supporting your Indirect Cost Rate.

-   If you have any questions about cost categories, or how to formulate
    some of your budget items, please email
    <NPS_PreserveAmerica@nps.gov>.

  ------------------------ ------------ ----------- ----------- -----------
  **1. Personnel**.                                             
  Provide the names and                                         
  titles of key project                                         
  personnel. Include only                                       
  the percentage of time                                        
  used on the project.                                          
  Please note that grant                                        
  funds may not be used to                                      
  pay Federal employee                                          
  salaries, nor may                                             
  Federal salaries be used                                      
  as match/cost share.                                          
  Please consult page 3 of                                      
  the guidelines for more                                       
  information on allowable                                      
  personnel costs.                                              

  Name/Title of Position   Wage or      Federal     Match /Cost Total
  and % of time spent on   Salary       Grant Funds Share (if   
  this Project                                      any)        

                           \$           \$          \$          \$

  ***Subtotal***                        \$          \$          \$
  ------------------------ ------------ ----------- ----------- -----------

  ------------------------ ------------ ----------- ----------- -----------
  **2. Fringe Benefits**.                                       
  If more than one rate is                                      
  used, list each rate and                                      
  the wage or salary base.                                      

  Rate                     Salary or    Federal     Match /     Total
                           Wage Base    Grant Funds Cost Share  
                                                    (if any)    

  \% of                    \$           \$          \$          \$

  ***Subtotal***                        \$          \$          \$
  ------------------------ ------------ ----------- ----------- -----------

  ------------------- ------ -------------- ----------- ------------ -----------
  **3.** **Consultant                                                
  Fees**. Include                                                    
  payments for                                                       
  professional and                                                   
  technical                                                          
  consultants                                                        
  participating in                                                   
  the project. Please                                                
  consult page 3 of                                                  
  the guidelines for                                                 
  more information on                                                
  allowable                                                          
  consultant costs.                                                  
  Maximum hourly                                                     
  rates charged to                                                   
  this grant may not                                                 
  exceed 120% of the                                                 
  salary of a Federal                                                
  Civil Service                                                      
  GS-15, Step 10,                                                    
  which in Fiscal                                                    
  Year 2008 was                                                      
  \$88.67 per hour or                                                
  \$685 per day.                                                     

  Name and Type of    \# of  Rate of        Federal     Match/Cost   Total
  Consultant          Days   compensation   Grant Funds Share (if    
                             or fixed rate              any)         
                             for project                             

                             \$             \$          \$           \$

  ***Subtotal***                            \$          \$           \$
  ------------------- ------ -------------- ----------- ------------ -----------

+--------------+----+----+---------+----------+-------+------+------+
| **4.**       |    |    |         |          |       |      |      |
| **Travel and |    |    |         |          |       |      |      |
| Per Diem**.  |    |    |         |          |       |      |      |
| Indicate the |    |    |         |          |       |      |      |
| number of    |    |    |         |          |       |      |      |
| persons      |    |    |         |          |       |      |      |
| traveling,   |    |    |         |          |       |      |      |
| the total    |    |    |         |          |       |      |      |
| days they    |    |    |         |          |       |      |      |
| will be in   |    |    |         |          |       |      |      |
| travel       |    |    |         |          |       |      |      |
| status, and  |    |    |         |          |       |      |      |
| the total    |    |    |         |          |       |      |      |
| subsistence  |    |    |         |          |       |      |      |
| and          |    |    |         |          |       |      |      |
| tr           |    |    |         |          |       |      |      |
| ansportation |    |    |         |          |       |      |      |
| costs.       |    |    |         |          |       |      |      |
+--------------+----+----+---------+----------+-------+------+------+
| From/To      | \# | \# | Subs    | Transp   | Fe    | Ma   | T    |
|              | of | of | istence | ortation | deral | tch/ | otal |
|              | Pe | Tr | Costs   | Costs    | Grant |      |      |
|              | op | av | (       | (Airfare | Funds | Cost |      |
|              | le | el | Lodging | and      |       | S    |      |
|              |    | Da | and Per | Mileage) |       | hare |      |
|              |    | ys | Diem)   |          |       | (if  |      |
|              |    |    |         |          |       | any) |      |
+--------------+----+----+---------+----------+-------+------+------+
|              |    |    |         |          | \$    | \$   | \$   |
+--------------+----+----+---------+----------+-------+------+------+
| **           |    |    |         |          | \$    | \$   | \$   |
| *Subtotal*** |    |    |         |          |       |      |      |
+--------------+----+----+---------+----------+-------+------+------+

  ------------------------ --------- ----------- ------------ -------------
  **5.** **Office Supplies                                    
  and Materials**. Include                                    
  consumable supplies and                                     
  materials to be used in                                     
  the project and any                                         
  items of expendable                                         
  equipment, i.e.,                                            
  equipment costing less                                      
  than \$5000 or with an                                      
  estimated useful life of                                    
  less than two years.                                        
  Equipment costing more                                      
  than that should be                                         
  listed in Equipment -                                       
  Category 6.                                                 

  Item                     Cost      Federal     Match/Cost   Total
                                     Grant Funds Share (if    
                                                 any)         

                           \$        \$          \$           \$

  ***Subtotal***                     \$          \$           \$
  ------------------------ --------- ----------- ------------ -------------

  ------------------------ --------- ----------- ------------ -------------
  **6. Equipment.** List                                      
  all equipment items in                                      
  excess of \$5000. Items                                     
  worth less than \$5000                                      
  or that have a useful                                       
  life of less than two                                       
  years must be listed in                                     
  Supplies and Materials -                                    
  Category 5.                                                 

  Item                     Cost      Federal     Match/Cost   Total
                                     Grant Funds Share (if    
                                                 any)         

                           \$        \$          \$           \$

  ***Subtotal***                     \$          \$           \$
  ------------------------ --------- ----------- ------------ -------------

  ------------------------ --------- ----------- ----------- -------------
  **7. Other (specify)**.                                    

  Item                     Cost      Federal     Match /     Total
                                     Grant Funds Cost Share  
                                                 (if any)    

                           \$        \$          \$          \$

  ***Subtotal***                     \$          \$          \$
  ------------------------ --------- ----------- ----------- -------------

+-----------------------+--------------+--------------+---------------+
| **BUDGET SUMMARY**    |              |              |               |
|                       |              |              |               |
| Enter category totals |              |              |               |
| here                  |              |              |               |
+-----------------------+--------------+--------------+---------------+
| **Category**          | **Federal    | **Match/Cost | **Total**     |
|                       | Grant        | Share**      |               |
|                       | Funds**      |              |               |
+-----------------------+--------------+--------------+---------------+
| **1. Personnel**      | \$           | \$           | \$            |
+-----------------------+--------------+--------------+---------------+
| **2. Fringe           | \$           | \$           | \$            |
| Benefits**            |              |              |               |
+-----------------------+--------------+--------------+---------------+
| **3. Consultant       | \$           | \$           | \$            |
| Fees**                |              |              |               |
+-----------------------+--------------+--------------+---------------+
| **4. Travel and Per   | \$           | \$           | \$            |
| Diem**                |              |              |               |
+-----------------------+--------------+--------------+---------------+
| **5. Supplies and     | \$           | \$           | \$            |
| Materials**           |              |              |               |
+-----------------------+--------------+--------------+---------------+
| **6. Equipment**      | \$           | \$           | \$            |
+-----------------------+--------------+--------------+---------------+
| **7. Other**          | \$           | \$           | \$            |
+-----------------------+--------------+--------------+---------------+
| **TOTAL PROJECT       | \$           | \$           | \$            |
| COSTS**               |              |              |               |
+-----------------------+--------------+--------------+---------------+

####  

+-----------------------------------------------------------------------+
| **\*\*\* IF USING WORD FORMAT YOU MUST DOWNLOAD**                     |
|                                                                       |
| **THE SF424 - APPLICATION FOR FEDERAL ASSISTANCE SEPARATELY AND       |
| SUBMIT WITH THIS COMPLETED APPLICTION \*\*\***                        |
|                                                                       |
| **The Due date for FY2009 Round 2 applications has yet to be          |
| determined. Please check our website,**                               |
| [www.nps.gov/history/hps/hpg                                          |
| /preserveamerica](http://www.nps.gov/history/hps/hpg/preserveamerica) |
| **for updates.**                                                      |
+-----------------------------------------------------------------------+

**[Application Submission]{.smallcaps}**

Applications must be submitted in hard copy. Faxed applications and
applications submitted electronically will not be accepted. Applications
not received by the deadline and incomplete applications will not be
considered. Additional materials sent separately from the application
will not be considered part of the application and will not be included
in evaluation of the application.

Application materials will not be returned. All application materials,
including photographs, become the property of the National Park Service
and may be reproduced by NPS or its partner organizations without
permission; appropriate credit will be given for any such use.

#### 

#### You must submit:

-   \(1\) original and five (5) copies -- a total of 6 --
    [complete]{.underline} application packages (preferably
    double-sided).

-   One (1) additional photocopy of page one of the application.

-   Page one of the application must be the first page in the original
    and copies. Do not use other cover pages.

-   The original must be secured with a binder clip.

-   Each copy must be **securely** held together with a staple or binder
    clip; do **not** use pocket folders, notebooks, or ring binders.

**A [complete]{.underline} application package includes:**

-   Application on 2009 form.

-   SF 424 Application for Federal Assistance (Download separately from
    the NPS website if using Word format)

-   Authorizing Official signature.

-   Timeline for project completion.

-   Detailed budget.

-   Necessary supplemental information to explain the project
    (photographs, maps, documentation of public/private partners, etc.)

**[\*\*\* note]{.smallcaps} - Applications should [not]{.underline} be
submitted through the US Postal Service. All US Postal Service mail to
Federal agencies in Washington, D.C. is irradiated, which can damage or
destroy materials and lead to a delay in delivery. You
[must]{.underline} submit your application via an alternate carrier.**

**SEND APPLICATIONS TO:**

Please address **ALL** support letters to the address below, attn:
Hampton Tucker; Chief, Historic Preservation Grants Division -- they
must accompany the grant application or they will **NOT** be considered.

*Preserve America* Grants

National Park Service

1201 "Eye" Street, NW

6^th^ Floor (ORG. 2256)

Washington, DC 20005

> **For more information please contact the National Park Service at:**
>
> **(202) 354-2020**
>
> nps_preserveamerica@nps.gov
>
> www.nps.gov/history/hps/hpg/preserveamerica