ATP Chapter/Affiliate Application Form

Name of tutorial association:_________________________________

(All address information should be for association contact officials.)

Mailing Address:____________________________________________________

City:  ___________________________State:  ______________________

Zip Code:___________

Phone Number:  ___________________  Fax:  __________________

E-mail Address:  __________________________________________

Name[s] and Title[s] of Association’s Governing Body:

Name                                      Title End of Current Term

___________________________________________________________

______________________________________________________

______________________________________________________

___________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

(All members of the governing body are required to be members of ATP.)

(Please submit a check for $25.00 for each member of the governing body and 

attach to this application.  ATP’s Tax ID number is: 80-0096151)

Documentation for Chapter/Affiliation:

Please include the following documentation:

1. Copy of Application Form
2. ATP membership application and check for governing officials of the association
3. Copy of tutorial association’s constitution/ mission statement.
4. Documentation of the numbers of members of the applying association

Send to: