Free 52782.pdf - Indiana

APPLICATION FOR FEDERAL PROFESSIONAL QUALIFICATIONS DOCUMENTATION FOR HISTORY
State Form 52782 (8-06)

INDIANA DEPARTMENT OF NATURAL RESOURCES DIVISION OF HISTORIC PRESERVATION AND ARCHAEOLOGY 402 West Washington Street, Room W274 Indianapolis, Indiana 46204-2739 Telephone: (317) 232-1646 Fax: (317) 232-0693 E-mail: [email protected]

Individual Name: Company/University Name: Address: City: Telephone: Email: State: Fax Number: Website: Zip Code:

We are requesting the following information to document that you meet or exceed the Federal requirements stated in "Archaeology and Historic Preservation: Secretary of the Interior's Standards and Guidelines," Federal Register, Vol. 48, No. 190-September 29, 1983, Pt. IV. The minimum professional qualifications are a graduate degree in history or a closely related field; or a bachelor's degree in history or closely related field, plus one of the following: 1. At least two years of full-time professional experience in research, writing, teaching, interpretation, or other demonstrable professional activity with an academic institution, historical organization or agency, museum, or other professional institution; or 2. Substantial contribution through research and publication to the body of scholarly knowledge in the field of history. A. List your graduate degree(s) in history. Include the degree, year, institution and area of specialization. ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________

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B.

List your graduate degree(s) in fields closely related to history. Include the degree, year, institution, and area of specialization. Briefly explain the relevance of your graduate training to the study of history. ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________

C.

List your bachelor's degree in history or a closely related field. Include the degree, field, year, and institution. For a degree in a field other than history, briefly discuss the relevance to the study of history. ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________

D.

Those without a graduate degree in history or a closely related field must demonstrate at least two years of full-time experience in history or a substantial contribution to scholarly research and publication history. 1. List your work experience in history, including your employer, dates of employment, title, nature of work, and length of experience converted to full-time months. Acceptable experience includes, but is not limited to, research, writing, teaching, or interpretation within an academic institution, historical organization or agency, museum, or other professional institution. _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ 2. List your scholarly research, publications, and reports in the field of history. If research listed here has not resulted in a report or publication, describe the use to which the results were applied. (Attach additional pages as necessary.) ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________

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ALL APPLICANTS

A.

Attach a statement with any other information or explanations which you would like to have considered. Attach a current resume or curriculum vitae to this completed form. The information submitted on this form and with the attachments to this form is accurate to the best of my knowledge. I understand that inclusion in the list does not constitute endorsement or guarantee of any individual consultant, any contracting firm or any consultant's work or work products. I also understand that it is my responsibility to inform the DHPA of any changes that may become necessary to the information provided. Name: ____________________________________ Signature: ____________________________________ Date: ____________________________________

B. C.

Submission: 1. Submit your documentation to the Indiana Division of Historic Preservation and Archaeology, 402 W. Washington Street, Room W274, Indianapolis, Indiana 462042739. The Indiana Division of Historic Preservation and Archaeology will review your documentation to determine if your qualifications meet the standards established by the National Park Service. If we determine your qualifications meet the standards, you will be added to the roster. If we find that you do not meet the standards, you will receive an explanation of why your qualifications do not meet the standards. Contact the Indiana Division of Historic Preservation and Archaeology with questions at the address above, by calling Karie Brudis at (317) 232-1646, or by E-mail: [email protected].

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