Application form for UW certificate program:
Advanced Interactive Marketing 2010 (Program ID# 3014)

---

Return to program description

To apply, please print, complete and mail this form with your required materials to the address below.

The 2010 program begins in January 2010. Applications are now being accepted and will be reviewed in the order they are received starting Oct. 12, 2009. Check the program status box on the right side of the How to Apply page to determine when the program is no longer accepting applications. Don't hesitate to call 206-685-8936 or e-mail us if you have any questions.

I wish to apply to the UW Certificate Program in Advanced Interactive Marketing. I enclose this completed form with a $50 nonrefundable certificate program fee and two stapled application sets, which include my résumé and letter of application.

Mr.    Ms.
Last name:
First name/middle initial:
Social Security # (required):
Date of birth:
Mailing address:
City/State/Zip:
Daytime phone:
E-mail address:

Method of payment:

	Check in U.S. funds made payable to the University of Washington. (Returned checks are subject to a $25 service fee.)
	Third-party payer: separate document (purchase order or letter of authorization to bill) must accompany this application.
	VISA
	MasterCard

Card number:
Expiration date:
Name as it appears on card:
Credit card billing address:
City/State/ZIP
Signature: