HER National Register Eligibility Worksheet.pdf

NATIONAL REGISTER ELIGIBILITY ASSESSMENT WORKSHEET

HISTORIC EQUAL RIGHTS GRANTS

Instructions: All Historic Equal Rights applicants must complete this form. To qualify, National Register eligibility must be directly associated with the struggle to achieve equal rights as outlined in Civil Rights in America, A Framework for Identifying Significant Sites (NPS, 2008). Photos, maps, or inventory forms may be provided to support the eligibility assessment. Applicants are encouraged to consult with their respective State or Tribal Historic Preservation Office early in the process for additional eligibility evaluation guidance.

1. Property Name

Street 1

Street 2

City County

State ZIP Code

Name of Historic District (if applicable)

2.Description of physical appearance Provide brief description of property and/or district, including features directly associated with the struggle to achieve equal rights.

Date of Building (mm/dd/yyyy)

Date(s) of Alteration(s), if Applicable(mm/dd/yyyy)

National Register Information System Number (if known) https://www.nps.gov/nhl/learn/themes/CivilRights_Framework.pdf https://www.nps.gov/nhl/learn/themes/CivilRights_Framework.pdf

Description of Physical Appearance (Attach additional forms if needed)

3. Statement of Significance

Provide brief statement justifying the significance of the building and/or district in association with the struggle to achieve equal rights and the dates of any specific events. If previously determined eligible note type of survey and dates. (Attach additional forms if needed)

4. Eligibility Certification (check one)

Property individually listed in the National Register of Historic Places or as a National Historic Landmark (NHL) for its association with equal rights significance.

Name of individual listing

Date of Listing(mm/dd/yyyy)

Contributing resource to a National Register or National Historic Landmark Historic District for its association with equal rights significance.

Name of District

Date of Listing (mm/dd/yyyy)

Preliminary determination that a property individually listed in the National Register or as an NHL contributes to the potential equal rights significance of the site, though currently not listed for that association.

Name of individual listing

Date of Listing (mm/dd/yyyy)

Preliminary determination that a property within a National Register or NHL Historic District contributes to the potential equal rights significance of the district, though currently not listed for that association.

Name of district

Date of Listing (mm/dd/yyyy)

Preliminary determination that a property is potentially eligible for listing in the National Register for its association with the struggle to achieve equal rights.

Name of site

Source/date of determination of eligibility (mm/dd/yyyy)

Preliminary determination that a property within a potential National Register historic district contributes to the equal rights significance.

Name of district

Source/date of determination of eligibility (mm/dd/yyyy)

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