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  • Kiel Program Application Form

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:

Email: kiel@duke.edu
Fax: 919-681-8774
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.

*See also the Certification of Health Care Provider Forms for employees and/or family members.

Form Name Format
file type icon Kiel Program Application Form
PDF
file type icon Kiel Program Application Form
Word

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Human Resources

Duke Human Resources
705 Broad St. Box 90496
Durham, NC 27705
Phone: (919) 684-5600
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