![]() ATP Tutor Certification ApplicationAll 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.
Associate, Advanced and Master Tutor certification & renewal packets (with 1 original & 3 copies of all materials) should be e-mailed to: Ms. Beth Nikopoulos Please submit application for certification and all verifying documents to bnikopoulos@dcccd.edu. Please send all certification fees to: Association for the Tutoring Profession
PO Box 198
Madison, NY 13402
OR pay through the secure website by
credit card or Paypal.
ATP Secure Website
ATP Secure Website
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