CERTIFICATE IN TEACHING ESL/EFL
Application Form
Date:__________________  
Last Name: ______________________________ First Name:___________________ MI:______
Daytime Phone:__________________________    Evening Phone:______________________
Fax number:_____________________________   Email address:_______________________
Address:________________________________________________________________________
City:_______________________ State:__________ Zip code:________________
   
___ I wish to enroll in Teaching English as a Second Language
___ I wish to enroll in Teaching English as a Foreign Language
How did you hear about our program? ________________________________________________
Is English your native language?   yes_____   no _____
   
Enrollment fee: ($60 nonrefundable, $40 late fee if you have taken more than one class before applying)
___ I have enclosed a check #_______ for $_______, 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 ______/______

 

Please include a 75-250 word statement on your educational and professional background, why you wish to enroll and how you plan to use the ESL Teaching Certificate.

Mail your statment, completed form, and application fee to:
Registration - ESL Teaching Certificate; Duke Continuing Studies; Box 90700; Durham, NC 27708-0700