CSKT

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 Preservation.

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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Map Attachment

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Please attach a map of location

Map Out Location

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Description of Project Location:

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Description of Activity to be Undertaken:

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Date Project will begin:(*)

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Cultural Clearance completion on or before(*)

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Attach Relevant Project Plans (if necessary):

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

YesNo Invalid Input

Cultural Clearances must be attained prior to completion of the NEPA process

(*)

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Culture Clearance Request Form