Pre-Development/HPTAG Form Completion Instructions

/ Pre-Development Historic Preservation Technical Assistance Grant (PD/HPTAG)
A collaborative historic preservation technical assistance program of the Connecticut Trust for Historic Preservation, in partnership with and funding from the State Historic Preservation Office, Department of Economic and Community Development

Pre-Development/HPTAG Form Completion Instructions

The Connecticut Trust for Historic Preservation PD/HPTAG form is available in Microsoft Word format or PDF. Please type application using either format, print it and MAIL one ORIGINAL COPY plus all required attachments to the Connecticut Trust (address below).

Please be sure to review all information and guidelines prior to completing and submitting the PD/HTPAG Application.

If you need additional information or have questions, contact:

Jane Montanaro

Preservation Services Officer

Connecticut Trust for Historic Preservation

Pre-Development/Historic Preservation Technical Assistance Grant (HPTAG)

940 Whitney Avenue

Hamden, CT 06517

E-mail:.

Fax: (203) 773-0107

Phone: (203) 562-6312

Applications are due (postmarked) by October 1, 2013.

Please note: HPTAG grants are now reimbursable grants. Funding will be allocated at the end of the grant period, upon approval of the Final Report.

Proposal Title: ______

One Sentence Proposal Summary (stating goal of project):

______

Grant Period: From: ______to: ______(One year max.)

Sponsoring Organization

Co-Sponsoring Organization

Organization Name: ______/ Organization Name: ______
Address: ______/ Address: ______
City: ______State: ____ Zip: _____ / City: ______State: ____ Zip: _____
Director: ______/ Director: ______
Phone: ______Fax: ______/ Phone: ______Fax: ______
Web: ______/ Web: ______
E-Mail: ______/ E-Mail: ______

Tax ID# (EIN) ______

501(c)(3) Organization? Yes / No
Signature: ______/

Tax ID# (EIN) ______

501(c)(3) Organization? Yes / No
Signature: ______

Project Director

Project Co-Director (if applicable)

Name: ______/ Name: ______
Institution: ______/ Institution: ______
Address: ______/ Address: ______
City: ______State: ____ Zip: _____ / City: ______State: ____ Zip: _____
Phone: ______Fax: ______/ Phone: ______Fax: ______
E-Mail: ______/ E-Mail: ______
Signature: ______/ Signature: ______

Fiscal Agent

Historic Resource Information

Name: ______/ Historic Name: ______
Institution: ______/ Address: ______
Address: ______/ ______
City: ______State: ____ Zip: _____
Phone: ______Fax: ______/ Date of Construction: ______
E-Mail: ______/ Number of Housing Units: ______
Architectural Period or Style: ______
Signature: ______/ Architect / Builder: ______

CT Legislative District: ______

Congressional District: ______

Funding Summary:
a) HPTAG Funds Requested / $ ______
b) Other External Funding / $ ______
c) Sponsor Cash / $ ______
d) In-Kind / $ ______
e) Project Totals / $ ______

Income, Budget and Use of Funds

Please provide a clear financial profile of project income and planned expenses below.

Note: Paid staff positions can be considered part of the Sponsoring Organization’s Cash Match.

Budget: Expenses Sources of Income and Matching Funds Total

Description of Expense / HPTAG Funds / In-Kind / Non-Cash / External Funding / Sponsoring Organizations Cash Match / Expense Total
Consultant #1 Fees:______/ $ ______/ $ ______/ $ ______/ $ ______/ $ ______
Consultant #2 Fees:______/ $ ______/ $ ______/ $ ______/ $ ______/ $ ______
Consultant #3 Fees:______/ $ ______/ $ ______/ $ ______/ $ ______/ $ ______
Personnel Salary: ______/ $ ______/ $ ______/ $ ______/ $ ______/ $ ______
Travel: ______/ $ ______/ $ ______/ $ ______/ $ ______/ $ ______
Supplies: ______/ $ ______/ $ ______/ $ ______/ $ ______/ $ ______
Rental: ______/ $ ______/ $ ______/ $ ______/ $ ______/ $ ______
Postage: ______/ $ ______/ $ ______/ $ ______/ $ ______/ $ ______
Telephone: ______/ $ ______/ $ ______/ $ ______/ $ ______/ $ ______
Printing: ______/ $ ______/ $ ______/ $ ______/ $ ______/ $ ______
Promotion: ______/ $ ______/ $ ______/ $ ______/ $ ______/ $ ______
Evaluation: ______/ $ ______/ $ ______/ $ ______/ $ ______/ $ ______
Other (Specify): ______/ $ ______/ $ ______/ $ ______/ $ ______/ $ ______
$ ______/ $ ______/ $ ______/ $ ______/ $ ______
Overall Total(s) / $ ______/ $ ______/ $ ______/ $ ______/ $ ______

Note: SOURCES OF INCOME MUST EQUAL OR SURPASS EXPENSES.

Budget Explanation: Append a detailed explanation of budget compilations, by category. For example, consultant’s fees, hourly rate and number of hours worked for the project director’s salary, how you determined travel costs, printing estimates, etc. Please provide this information both for grant funds requested and for cost-share.

Note: External Funds are funds raised for the project from other organizations, institutions or private individuals (not applicant’s own cash).

Please specify name and status of any external funds:

Name: ______Amount $ ______[ ] Confirmed [ ] Pending [ ] Needed

If the sponsoring organization is partnering with an unincorporated group, please provide a description.

Name of the unincorporated group: ______

Its purpose and recent activities: ______

Its active participants: ______

Plans for future growth: ______

If the building/property is not owned by the applicant, please complete the following:

Owner’s Name: ______

Owner’s Address: ______

______

Phone: ______Fax: ______

E-Mail: ______

Attach a letter of approval for the project from the owner detailing the owner’s involvement with the project.

Project Information

1. Project Goals:

1.1. What specific historic preservation need or challenge does this project address?

1.2. What research or activity led you to know this project is needed? Building maintenance plan? Other?

1.3. Is this project related to a significant or larger preservation or revitalization effort in the community?

1.4. Is this a high profile project in the state of Connecticut? (Tourism potential)

1.5. How will the successful completion of this project contribute to building the capacity of your organization or furthering its mission?

1.6. Since this is a Pre-Development grant request it is assumed you will funding from the state’s Historic Restoration Fund . Plans and Specifications developed from this grant MUST conform to the Secretary of the Interior’s Standards for Treatment of Historic Buildings. Please indicate here that you are aware of this requirement. How will you ensure compliance?

1.7. What plans do you have for this site beyond the scope of this project?

2. Community Support

2.1. Who are the other stakeholders in this project?

2.2. Is the building widely used by community or used in a manner that improves the quality of life for residents?

2.3. Provide at least 3 letters of support of the project from stakeholders, town officials, legislators or other relevant parties.

3. Capacity of the Organization

3.1. Is the cash match for this grant already in place?

3.2. Will this projected be completed within the next 12 months? If no, explain.

3.3. Give two brief examples of recently completed projects. If this is the organization’s first grant project, please describe the organization’s capacity to see the project through to a successful completion.

4. Historical and Architectural Significance

4.1 Describe the historical and architectural significance of the building/site.

4.2 Is the site part of a larger cultural landscape or historic neighborhood?

4.3 Provide 10 recent color photographs of the resource, submitted on disk/CD. The photographs should support the proposed project and should include: a CONTEXT image (depicting the location of the building, such as, an aerial view, streetscape, neighborhood or city map); front, back, and side views, a ¾ view, pertinent interior views, and any other views or details that are important to explaining the nature of the project.

[ ] Photographs showing site / context

[ ] Photographs of the exterior including details

[ ] Photographs of the interior

[ ] Digital copy of all photographs (CD)

4.4 Historic Designations:

Is the project site recognized for its architectural/cultural/historical significance by any of the following designation programs: (Check all that apply.)

Yes / No
National Historic Landmark / [ ] / [ ]
National Register of Historic Places / [ ] / [ ]
Individually listed / [ ] / [ ]
Contributing to a District
District Name: ______/ [ ] / [ ]
State Register of Historic Places, required. / [ ] / [ ]
Individually listed / [ ] / [ ]
Contributing to a District
District Name: ______/ [ ] / [ ]
Local Historic Resource Survey / [ ] / [ ]
Historic American Buildings Survey (HABS) / [ ] / [ ]
Historic American Engineering Record (HAER) / [ ] / [ ]
Other: (specify)______
If you checked “no” to all categories, your organization must begin process of listing the property on the State Register of Historic Places. Provide an eligibility statement or “approval for study” letter from the State Historic Preservation Office, DECD, with your application. / [ ] / [ ]

5. Participating Consultants: Consultants names must come from the State Historic Preservation Office’s list of approved Historic Consultants which may be obtained from your Circuit Rider or .

5.1 Non-Profits: Please attach resumes of all consultants contacted to bid on this project.

5.2 Municipalities: Please attach a draft Request for Proposal/RFP.

5.3 Provide consultants’ work plan and indicate how many team members will work on each phase. Include it in the attachments. Note: Work Plan should not to exceed 12 months.

Step 1: Action and Date(s). Include # of consultants who will perform task, including support staff.

Step 2: Action & Date(s). Include # of consultants who will perform task, including support staff.

Step 3: Action & Date(s). Include # of consultants who will perform task, including support staff.

Submission Information and Required Attachments

Attach to Master Copy with a paper clip: (please - no staples or bindings!)

1. Evidence of incorporation in the state of Connecticut.

2. A list of applicant’s board members with contact information: home addresses, emails and phone numbers.

3. A financial statement for your most recent fiscal year and a brief description of your most recent activities.

4. Letter of consent and describing involvement in the project from building owner (if different from the applicant).

5. Letters of support. Letters should be provided by all stakeholders, legislators, and those providing matching funds. Minimum of 3 letters required.

6. Consultants’ Resumes or, if a municipality, a sample RFP.

7. One DISK containing 10 photographs of the historic resource taking care to show site CONTEXT, exterior elevations, architectural details, and interior images. Please identify images with names and please limit images to 10.

8. Provide a LOCATION map (town or area map or Google satellite image with the site clearly identified.) Provide this on hardcopy or disk.

Grant Application Checklist: Please make sure all items are included with the Master Copy.

1. Have you submitted a Pre-Application prior to submitting this proposal?

a. If you have not, contact the Connecticut Trust for Historic Preservation before you proceed.

2. Have you secured all the necessary signatures on the cover sheet?

3. Have you enclosed the original signed Master Copy Pre-Development/HPTAG Application Hardcopy

4. Have you included the following with the Master Copy –

All Hardcopy: Late attachments will not be accepted.

§ Consultants Resumes and Work Plans (or draft RFPs)

§ Letters of Support (provide at least 3)

§ Letter of incorporation in the state of Connecticut

§ List of all Board Members

§ Most recent Fiscal Year Financial Statement of your organization

§ Brief description of your organization’s recent activities

§ If applicable: Letter of Approval from property owner, Budget explanations, Letter(s) of Commitment from external funding sources.

5. Have you double-checked your budget for accuracy? Do you have enough matching funds?

6. Have you included photographs? Disk

7. Have you included a location map? Hardcopy or disk.

Mail application, attachments and disk to