Achievement Tutoring ATP Portal Exemption Form

* required field

This one-time form is to document a student who was not entered into the ATP portal, that you provided services for during Session Two. Please direct questions to Linda Burrows at [email protected].

This is a one-time fixed for the new ATP Portal. Next session this option will not be available. You will need to address all ADEConnect issues prior to the deadline of April 17th.

ADEConnect Help Desk Ticket - https://helpdesk.azed.gov/app/itdesk/HomePage.do
ADEConnect Phone Line - 602-542-7378, ext. 8

Notice: You are submitting personal identifiable information and ADE will handle this information as confidential.

Local Education Agency Information

LEA, Charter, ATP Tutoring Provider Name *

ATP Manager Name *

ATP Manager Contact Email *

Student Information

Student Full Name *

Student SSID Number *

Student Date of Birth *

Month

Day

Year

Tutor Information

Tutor Full Name *

Tutor Contact Email *

Subject Tutored *

Reading

Writing

Math

ACT Prep

Tutoring Hours *

Attestation

Attendance Documents *

Upload Attendance Verification Documents in PDF, Excel, Word or image format.

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