North Carolina Historic Preservation Fund

North Carolina Historic Preservation Fund is sponsored by North Carolina Department of Natural and Cultural Resources. Provides matching grants for the preservation of historic properties in North Carolina.

www. hpo. nc.

gov Page 1 of 4 Phone: 919-814-6582 # 202 6 HISTORIC PRESERVATION FUND (HPF) GRANT FOR CERTIFIED LOCAL GOVERNMENTS (CLG) APPLICATION FORM (Deadline 11:59 p. m.

April 30, 202 6) PROJECT INFORMATION (Please complete) Name of project:_______________________________________________________________ Project Type: __ Archaeological Investigation __ Architectural/Archaeological survey __ National Register (NR) nomination __ Survey publication manuscript __ Architectural/engineering study. Name of NR property:____________________________ __ Restoration/rehabilitation.

Name of NR property: ________________________________ __ Educational Program __ Other (specify): ____________________________________________________________ CLG GRANT - APPLICANT INFORMATION (CLG, or CLG commission) Name of CLG governing board or CLG commission: ____________________________________ Contact person: __________________________________ Title: ____________ _____ Address: ______________________________________________________________________ Telephone: _________________________ E-mail: ____________________________________ Federal ID # __________________________ Only CLGs or CLG commissions may apply for CLG grants.

If the CLG is applying at the request of a nonprofit or educational institution, provide the following information: Name of nonprofit or educational institution: ________________________________________ Contact person: __________________________________ Title: __________ ____________ Address: ______________________________________________________________________ Telephone: __________________________ E-mail: ______________________ **Please attach the CLG commission’s review comments or letter of support for this application.

Person who will be the local project coordinator (in most cases this will be the CLG staff): Name: ______________________________________ Title: ___________________________ Local government or organization: ________________________________________________ Address: _____________________________________________________________________ Telephone: ____________________________ E-mail: ___________________________ www. hpo. nc.

gov Page 2 of 4 Phone: 919-814-6582 Name of donor: _______________________________________________________________ Source of funds (e.g., general fund, private donations, foundation funds, etc): ______________ ____________________________________________________________________________ Amount of cash: __________ Other: _____________ Date Available: _______ Attach list if more than one donor.

BUDGET: AN ESTIMATE OF PROJECT COSTS Submit an itemized budget for work to be accomplished with the proposed grant project and matching funds. Suggested matching funds are forty percent of total project costs. Please contact the grants coordinator if you have a project in mind, but the local government is unable to support a forty percent match.

Budget Item: Estimated Cost: ___________________________ $________________ ___________________________ ________________ ___________________________ ________________ ___________________________ ________________ ___________________________ ________________ TOTAL ESTIMATED PROJECT COST $ ________________ GRANT REQUEST $ __________ LOCAL MATCHING FUNDS $ __________ Budget Notes: Cash funds must be available for payment of direct costs, such as consultant/contractor fees, duplicating, and newspaper notices (for National Register historic districts with more that 50 owners).

Be sure that grant funds are matched with sufficient local nonfederal cash match to meet this requirement. Funds should be available through the project completion deadline of February 2 9, 202 8.

** Please attach a completed “Equal Opportunity Statement” signed by the applicant (see page 4) On a separate page, briefly describe what will be accomplished with the grant and matching funds and briefly describe how the project meets the goals of North Carolina's historic preservation plan for 20 25 -20 34 (see goals, attached). * Please limit the abstract to three double- spaced pages .

 Attach an abstract of the proposed project and signed Equal Opportunity Statement.  Contact Historic Preservation Office (HPO) staff for assistance in developing the project description and estimating the budget. A site visit may be needed.

HPO staff contact information is listed in the Instructions.  Applications for architectural surveys must include the estimated number of acres or square miles and estimated number of properties to be surveyed. www.

hpo. nc. gov Page 3 of 4 Phone: 919-814-6582  Properties and districts proposed for nomination to the National Register must be on the HPO Study List and/or deemed potentially eligible by HPO staff.

 National Register historic district applications must include a map of the district and its estimated number of properties.  National Register historic district nomination proposals must demonstrate local support.  Archaeological survey project abstracts must be accompanied by a map (USGS Quad) showing the area(s) to be covered and an estimate of the acreage to be covered.

 Applications for predevelopment or development projects must include photos of the structure.

******************************** ** Historic Preservation Office or Office of State Archaeology staff member contacted regarding this application: ____________________________________________________ ______________ Name of HPO/OSA Staff Contacted DATE CLG Applicant or Other Applicant: ____________________________________________________ ______________ SIGNATURE of local government official DATE or officer of the Applicant ____________________________________ ________________________________ If the applicant above is a local government or local historic preservation commission applying at the request of a non-profit organization or educational institution, an official of the nonprofit organization or educational institution must sign below: ____________________________________________________ ______________ SIGNATURE of official of nonprofit or educational institution DATE submitting application through a local government or historic ____________________________________ ________________________________ NAME TITLE www.

hpo. nc. gov Page 4 of 4 Phone: 919-814-6582 Addendum to Grant Application THE NORTH CAROLINA STATE HISTORIC PRESERVATION OFFICE RECEIVES FEDERAL FUNDS FROM THE NATIONAL PARK SERVICE.

REGULATIONS OF THE U.S. DEPARTMENT OF THE INTERIOR STRICTLY PROHIBIT UNLAWFUL DISCRIMINATION IN FEDERALLY ASSISTED DEPARTMENTAL PROGRAMS ON THE BASIS OF RACE, COLOR, NATIONAL ORIGIN, RELIGION, SEX (INCLUDING PREGNANCY AND GENDER IDENTITY), AGE, DISABILITY, SEXUAL ORIENTATION, OR GENETIC INFORMATION, OR REPRISAL FOR PROTECTED EEO ACTIVITY IN ITS FEDERALLY ASSISTED PROGRAMS.

ANY PERSON WHO BELIEVES HE OR SHE HAS BEEN DISCRIMINATED AGAINST IN ANY PROGRAM, ACTIVITY, OR FACILITY OPERATED BY A RECIPIENT OF FEDERAL ASSISTANCE SHOULD CONTACT THE EQUAL OPPORTUNITY PROGRAM OFFICE, U.S. DEPARTMENT OF THE INTERIOR, NATIONAL PARK SERVICE, 1849 C STREET, NW, MAIL STOP 7360, WASHINGTON, D. C. 20240; VISIT HTTPS://WWW.

DOI. GOV/PMB/EEO OR PHONE (202) 208-5693.

CLG Applicant or Other Applicant: ______________________________________________________ Signature Date ______________________________________________________ Name Title ______________________________________________________ Name of local government, local historic preservation commission, nonprofit, or educational institution Project: ______________ **If the applicant is a local government or local historic preservation commission applying at the request of a non-profit organization or educational institution, an official of the nonprofit organization or educational institution must sign below: _____________________________________________________ _____________________________________________________ _____________________________________________________ Name of nonprofit or educational institution Note : Acknowledgement of the Equal Opportunity Statement above shall accompany each application for federal funding.

Receipt of this signed and dated statement will fulfill this requirement. The applicant must sign the statement; and, if the applicant is a local government or local historic preservation commission applying at the request of a nonprofit or educational institution, the nonprofit or educational institution must also sign the statement.