Kiel Program Application Form
To apply to receive donations from the Kiel Program, please complete the Kiel Program Application Form below along with a Certification of Health Care Provider Form*. The Kiel Program Application Form is submitted to your supervisor and payroll representative, and then forwarded to Benefits for processing. The Kiel Program Application Form should be sent to Duke Benefits:
|Mail:||705 Broad Street (Box 90502)
Durham, NC 27705
In order to ensure that submitted forms are processed in time for payroll cutoff schedules, all documents (applications, certifications of health care providers, and donations) will need to be submitted to the Duke Benefits (see above) no later than noon on the cutoff dates listed here. Final approval by Benefits is required.
|Kiel Program Application Form|
|Kiel Program Application Form||Word|