Culture Clearance Request Form

This form is used for obtain Cultural Clearance and a MINIMUM OF 14 DAYS IS REQUIRED FOR ALL CLEARANCES. If you have questions regarding this form, please contact either Clarinda Burke at ext. 1075 or Kyle Felsman at ext. 1108 or Wain Lefthand at ext. 1292 or Aggie Incashola at ext.1078
Applicant Name:(*)
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Department Name:(*)
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Applicant Email:(*)
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Township:
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Range:
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Section(s):
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Please attach a map of location or map out the location on the Google map below.
Map Attachment
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Map Out Location

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Township:
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Range:
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Section(s):
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Description of Project Location:
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Description of Activity to be Undertaken:
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Attach Relevant Project Plans (if necessary):
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Cultural Clearances must be attained prior to completion of the NEPA process
Request to be evaluated by NEPA Categorical Exclusion?(*)
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Date Project will begin:(*)
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Cultural Clearance completion on or before:(*)
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(*)

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