ATP Tutor Certification Application
All certification applications should be typed. Please do not submit handwritten forms.
Name to be printed on certificate:
_______________________________________________________________
Mailing Address: ____________________________________________________
City: ________________________ State: ________ Zip Code:________
Phone Number: ____________________ Fax Number: _____________________
E-mail Address: _____________________________________________________
Name of Institution/Tutor Program: ________________________________________
___________________________________________________________________
Below please circle the desired tutor certification level and whether this application is for a new ATP tutor certification or a renewal of an existing tutor certificate.
|
Tutor Certification Levels |
New Certification |
Renewal |
|
Associate Tutor |
$10.00 |
$5.00 |
|
Advanced Tutor |
$20.00 |
$10.00 |
|
Master Tutor |
$30.00 |
$15.00 |
Associate, Advanced and Master Tutor certification & renewal packets (with 1 original & 3 copies of all materials) should be mailed to:
Ms. Beth Nikopoulos Assistant Director Student Life North Lake College
5001 N. MacArthur Blvd.
Irving, Texas 75038 Please complete this form and send with a check to ATP and the required documentation to Ms. Nikopoulos or send her the documentation with this form and pay through the secure website by credit card or Paypal. ATP Secure Website
