CERTIFICATE IN DOCUMENTARY STUDIES
Application Form
(See instructions at bottom.)

Date:  __________________

Name:  ____________________________________________________________
                                First                               MI                             Last

Address: _____________________________________________________

City: _____________________ State: ____  Zip code: ________________

Evening Phone: ___________________ Daytime Phone: __________________

Fax number: _____________________ Email address: _____________________

How did you hear about this program? ___ Catalog ___ Web ___ Other

Enrollment fee: 

___ I have enclosed a check for $60, made payable to Duke University


          ___ Payment by MasterCard/Visa

                   Credit Card Billing Information (please print)

                   First Name ____________________________ Last Name _______________________
                   Address __________________________________________________________
                   City/State/Zip_____________________________Country(if not USA)_____________
                   Total Amount $_______________               ____MasterCard          ___Visa

                   Card Number ________    ________    ________    ________    Exp. Date _____/_____

Personal statement:

Please include a brief (75-250 word) statement describing work experience, academic or other training, and your goals in the program.

Mail your completed application form, fee, and statement to:

Registration - Certificate in Documentary Studies
Duke Continuing Studies
Box 90700
Durham NC 27708-0700

Or fax it: 919-681-8235