ATP Peer Tutor Certification Application Form

Name to be printed on certificate:  __________________________________

Mailing Address:  _______________________________________________

City:  ___________________________State:  ______________________

Zip Code:___________

Phone Number:  _______________  Fax:  __________________________

E-mail Address:  _______________________________________________

Name of Institution/tutor program:  ________________________________

_____________________________________________________________

Certification Level Requested:

Peer Tutor Level 1: _______  Associate Peer Tutor Level 2:  _______  Master Peer Tutor Level 3:______

Application Fee:  $15.00 per year

(Please submit a check for $15.00 payable to ATP Tutor Certification.  Attach to this application.  ATP’s Tax ID number is: 80-0096151

Documentation for Certification List:

Please include documentation for the following:

1. Copy of ATP student membership or cancelled check for membership
2. Documentation of training, including the number of hours (CRLA Certificate would be accepted as documentation)

3. Copy of transcript with subjects you want to tutor highlighted.

4. Three letters of recommendation:

   One from tutor supervisor

   One from an instructor of one or more content areas you are tutoring

   One from instructor in your major field of study

5. Provide documentation that you have completed the appropriate number of supervised tutoring sessions.  (Documentation might be a signed statement from your tutor supervisor indicating the number of supervised hours you have tutored.)
6. An overview of tutor training program including topics and methods of training or a copy of your CRLA certificate.
7. For Levels 2 and 3:  Provide certificates or documentation of each level of training completed.
8. Complete application form
9. Submit certification fee

Send 1 original and 3 copies to: