ATP Tutor Trainer Application Form
ATP Tutor Trainer 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 trainer certification level and whether this application is for a new ATP tutor trainer certification or a renewal of an existing tutor trainer certificate.
|
Tutor Trainer Certification Levels |
New Certification |
Renewal |
|
Tutor Trainer |
$40.00 |
$20.00 |
|
Master Tutor Trainer |
$50.00 |
$25.00 |
Tutor Trainer and Master Tutor Trainer certification & renewal packets (with 1 original & 3 copies of all materials) should be mailed to:
Dana L. Welch, M.S.Director, Academic Success
The University of Texas at Tyler
3900 University Blvd., Tyler, TX 75799
