ATP Application Form
Name to be printed on certificate:
_________________________________________________________
Mailing Address: ____________________________________________________
City: ________________________State: ________Zip Code:_____
Phone Number: _________________________________________
Fax Number: ___________________________________________
E-mail Address: _________________________________________________________
Name of Institution/tutor program: __________________________________________________________________________________________________________________
|
Certification |
New |
Renewal |
|
Associate Tutor* |
$10.00 |
$5.00 |
|
Advanced Tutor* |
$20.00 |
$10.00 |
|
Master Tutor* |
$30.00 |
$15.00 |
|
Tutor Trainer* |
$40.00 |
$20.00 |
|
Master Tutor Trainer* |
$50.00 |
$25.00 |
*Associate, Advanced and Master Tutor certification please send one original and three copies to:
Ms. Beth Nikopoulos Assistant Director Student Life North Lake College5001 North MacArthur Blvd
Irving, Texas 75038
*Tutor Trainer and Master Tutor Trainer certification please send one original and three copies to:
Ms. Beth Nikopoulos Assistant Director Student Life North Lake College5001 North 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
