Free Editing Application - Federal

OMB Control No. 3095-0012 Expires: March 31, 2012

APPLICATION FOR The NHPRC Institute for the Editing of Historical Documents (Please type) 1. NAME: ________________________________________ DATE:_________________________ 2. CURRENT ADDRESS INFORMATION Mailing address: _____________________________________________________ _____________________________________________________ _____________________________________________________ Telephone No(s): Home: ( ) ___________________ Office: ( ) ___________________

E-mail address: ____________________________________________________________________ 3. SUMMER ADDRESS INFORMATION (if applicable) Mailing address: _____________________________________________________ _____________________________________________________ _____________________________________________________ Telephone No(s): Home: ( ) ___________________ Office: ( ) ___________________

E-mail address: ____________________________________________________________________ 4. PRESENT INSTITUTIONAL AFFILIATION and ADDRESS: _____________________________________________________ _____________________________________________________ _____________________________________________________

5. PRESENT OCCUPATIONAL POSITION: ____________________________________________________________________________________

6. PRESENT DUTIES: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

7. COLLEGES ATTENDED, DEGREES EARNED, And YEARS CONFERRED: ________________________________________________________ ________________________________________________________ ________________________________________________________ 8. PUBLICATIONS, IF ANY: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 9. DOCUMENTARY EDITING EXPERIENCE, IF ANY: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _________________________________________________________________________________ 10. On a separate sheet, please explain your reasons for wanting to attend the Institute, and describe in detail the content and scope of your ongoing work editing historical documents (e.g., the nature of the documents you plan to edit, your progress in locating a possible publisher, the amount of work already completed, etc.). ____________________________________________________________________________________ Public Burden Statement

The information requested on this form is being collected and used to evaluate applicants for the Institute for the Editing of Historical Documents. We estimate the public burden per response is 2 hours to read the instructions, gather necessary data, and complete the information collection. In accordance with 36 CFR 1206.58, you must provide the information in order to be considered for the Institute. The Paperwork Reduction Act requires us to notify you that a Federal agency may not conduct or sponsor, and you are not required to respond to a collection of information unless it displays a currently valid OMB control number. The OMB control number for this information collection is 3095-0012. Send comments regarding the burden estimate or any other aspect of the collection of information, including suggestions for reducing this burden, to National Archives and Records Administration ( NHP), Room 3200, 8601 Adelphi Road, College Park, MD 20740-6001, and to the Office of Management and Budget, Paperwork Reduction Project (3095-0012), Washington, DC 20503. DO NOT SEND COMPLETED FORMS TO THESE ADDRESSES. Send these forms to Editing Institute, NHPRC, Room 106, National Archives and Records Administration, 700 Pennsylvania Avenue, NW, Washington, DC 20408-0001.