Application form for UW certificate program:
User-Centered Design

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Return to program description

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

All applications must be received in UW Extension offices by 5 p.m. on the deadline for each program start as indicated below. After this deadline, applications may be accepted on a space-available basis, and you are encouraged to call 206-685-8936 or e-mail us to inquire about space availability. Students may apply now for any upcoming quarter before the dates listed below.

I wish to apply to the UW Certificate Program in User-Centered Design. I enclose this completed form with a $50 nonrefundable certificate program fee and three stapled application sets, which include my letter of application and résumé.

Please select program preference:

Winter Quarter 2010 (Program ID# 3230)
Application deadline Nov. 13, 2009

Spring Quarter 2010 (Program ID# 3021)
Application deadline Feb. 12, 2010

Note: It is the applicant's responsibility to make sure that all required materials are submitted with the application. All applicants will be evaluated on the basis of materials submitted.

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 form.
	VISA
	MasterCard

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