Certificate in Documentary Arts Application Form Today’s date: ____________________________________________________

Name: __________________________________________________________

Address: ________________________________________________________

City/State/Zip: ____________________________________________________

Daytime phone: _________________ Evening phone: __________________

Email: __________________________________________________________

Enrollment Fee I have enclosed a check for $80, payable to CDS at Duke University

I will make/have made this payment online*

*To pay online, visit cdscourses.org and log in to your account (or create a new account). Under “Services” on the left side of the screen, select “Apply for Certificate” or “Distance Certificate,” add the certificate to your shopping cart, and continue to the payment page.

Statement of Interest

Please write a brief statement (75–250 words) describing your work

experience, academic training, and goals for the program, including possible

final project ideas. Email it to cdscourses@duke.edu, fax it to

919-681-7600, or mail it with this form to:

Certificate in Documentary Arts Center for Documentary Studies at Duke University Box 90802 Durham, NC 27708-0802

For more information on the Certificate in Documentary Arts, contact:

April Walton, Director or Marc Maximov, Coordinator

Continuing Education Continuing Education

april.walton@duke.edu marc.maximov@duke.edu

(919) 660-3670 (919) 660-3678