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Kiel Program Donor Form

To donate to the Kiel Program, a donor must complete a Vacation or PTO Donation Form. The Donor Form is submitted to the donor's department payroll representative, who forwards it to Duke Benefits. The Kiel Program Donor Form should be sent to Duke Benefits:

Fax: 919-681-8774
Mail: 705 Broad Street (Box 90502)
Durham, NC 27705

In order to ensure that submitted donation 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 Benefits Department (fax 919-681-8774) no later than noon on the cutoff dates listed here. Final approval by Benefits is required.

Form NameFormat
Kiel Donor FormPDF
Kiel Donor FormWord


Benefits - Work Absences, Kiel Program