Cultural Clearance Request Form

Culture Clearance Request Form

This form is used for obtain Cultural Clearance and a MINIMUM OF 12 TRIBAL BUSINESS DAYS IS REQUIRED FOR ALL CLEARANCES. If you have questions regarding this form, please contact either Kathryn McDonald, Compliance Manager, at ext. 1082 or Kyle Felsman, Tribal Historic Preservation Officer, 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

Date Project will begin:(*)

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Cultural Clearance completion on or before(*)

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Request to be evaluated by NEPA Categorical Exclusion?(*)

YesNo Invalid Input

(*)

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Culture Clearance Request Form

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