MCR20-005 02/20
Certified Historical Institutions | Tier 2
APPLICATION FOR TIER 2 CERTIFICATION
Date___________________________________________
Please refer to Guidelines for details of requirements and benets of each.
Section I: ABOUT YOUR ORGANIZATION
Name of Organization _______________________________________________________________________________
Mailing Address ____________________________________________________________________________________
City _________________________________________________________________ ZIP Code ____________________
Physical Address ____________________________________________________________________________________
City _________________________________________________________________ ZIP Code ____________________
Phone _________________________________________ Email _____________________________________________
Contact Person _____________________________________________________________________________________
Contact Phone _______________________________ Contact Email ________________________________________
Alternate Contact ___________________________________________________________________________________
Phone _________________________________________ Email: _____________________________________________
Section II: QUALIFYING QUESTIONS:
AHS Support
Does your museum/historical organization hold an active Arizona Historical Society (AHS) membership at the
Institutional or higher level? (Required for certication.) YES NO
Public Trust and Accountability
Does your organization comply with local, state and federal laws, codes and regulations applicable to its
facilities, operations and administration? YES NO
Is your organization committed to public accountability and is it transparent in its mission
and operations? YES NO
Mission and Planning
Does your organization have a clear understanding of its mission and communicates why it exists and who
benets as a result of its efforts? YES NO
Is your organization guided by a mission statement that clearly describes the purpose of the organization, and
a vision statement that clearly describes the organization’s future direction? YES NO
MCR20-005 02/20
Leadership and Organizational Structure
Is your organization a Non-Prot 501c3? YES NO
Is your organization a Sovereign Nation? YES NO
Does your organization have a governing structure, including by-laws, articles of incorporation,
and a board of directors/trustees? YES NO
Does your organization conduct business meetings and hold elections on a regularly
scheduled basis? YES NO
How often are business meetings held? ____________ How often are elections held? ____________
Do the governance, staff and volunteer (as applicable) structures and processes effectively advance the
organization’s mission? YES NO
Does your organization have volunteers that support the organization? YES NO
Education and Interpretation
Does your organization offer educational and public programs, special events and other activities that are tied
to your mission? YES NO
Please describe examples of programs/events. (You may also include iers of past or upcoming programs.)
____________________________________________________________________________________________________
Does your organization present accurate, appropriate, and unbiased content for each
of its audiences? YES NO
A minimum of 108 hours per year serving the public through either museum hours open to the public or
public programming (or a combination of both).
How many hours per year is your organization open to the public? ____________
How many hours of programming does your organization provide to the public per year? ____________
Does your organization provide regular audience engagement that promotes
the value of history? YES NO
Financial Stability
Does your organization legally, ethically and responsibly acquire, manage and allocate its nancial resources
in a way that advances its mission? YES NO
Facilities and Risk Management
Is your organization’s facility clean, well-maintained and provides for the safety and
needs of your visitors? YES NO
Certified Historical Institutions | Tier 2, cont.
MCR20-005 02/20
Attachments required
Organization’s mission statement
Organization’s vision statement
501c3 IRS letter, OR Sovereign Nation
designation documentation
Roster of current board of directors/trustees
(Names only)
Examples of mission-driven public education and/
or special events
2—4 pictures of museum; one exterior; and
2—3 exhibit or program/event photos
I hereby afrm that the above information is true and correct.
Name _____________________________________________________________________________________________
Title _______________________________________________________________________________________________
(President or Director required.)
Signature __________________________________________________________________________________________
Date _____________________________________________
Email completed form to: certied@azhs.gov
Or mail to: Arizona Historical Society | 1300 N. College Ave. | Tempe, AZ 85281
Certified Historical Institutions | Tier 2, cont.
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