HPF-Generic_NR-EligibilityWorksheet_2021-11-03_508.pdf

NATIONAL REGISTER ELIGIBILITY ASSESSMENT WORKSHEET

HISTORIC PRESERVATION FUND GRANTS

Instructions: This worksheet is required if stipulated by the grant opportunity's application instructions section D. If so, the application instructions (Notice of Funding Opportunity) specify in section A2 “Background, Purpose and Program Requirements” the necessary associated significance and may have further instructions in section D.

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. Eligibility Certification

□ Property is listed in the National Register of Historic Places (NRHP) or designated a National Historic Landmark (NHL)

□ Listed individually

□ Listed as a Contributing resource to a NRHP or NHL historic district

□ The documented Significance of the listing includes the necessary criteria or associations required by the grant program as specified in the application instructions section A2 “Background, Purpose and Program Requirements”.

□ Property has a preliminary determination of eligibility from the cognizant State or Tribal Historic Preservation Office

□ To be listed individually

□ To be listed as a Contributing resource to a NRHP or NHL historic district

□ To update an existing NRHP listing or NHL designation

□ Expressly for the necessary criteria or associations required by the grant program as specified in the application instructions section A2 “Background, Purpose and Program Requirements”.

2. Property Information

Property Name:

Street Address:

City:

State:

County:

Zip Code:

Name of Historic District (if applicable):

National Register Information System Reference Number (if known):

https://www.nps.gov/subjects/nationalregister/index.htm https://www.nps.gov/subjects/nationalhistoriclandmarks/index.htm https://www.nps.gov/subjects/nationalregister/database-research.htm

3. Description of Physical Appearance Provide a brief description of the property and/or district, including features directly associated with the necessary significance required by the grant program as specified in the application instructions section A2 “Background, Purpose and Program Requirements”.

Date of Building Construction (mm/dd/yyyy)

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

Description of Physical Appearance (attach additional materials if necessary)

4. Statement of Significance Provide a statement of the significance of the property and/or district with regards to the necessary criteria or associations required by the grant program as specified in the application instructions section A2 “Background, Purpose and Program Requirements”.

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HPF-Generic_NR-EligibilityWorksheet_2021-11-03.pdf

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