ACTLA Certification Fee Invoice Request
Once your request is received and processed, you will be emailed a PayPal invoice that will allow you to pay by credit/debit card.  Review of your application will begin after payment is received.

Revised 09/28/2021
Sign in to Google to save your progress. Learn more
01. First Name of person to whom the invoice will be emailed.
02. Last Name of person to whom the invoice will be emailed.
03. Email
04. Online Tutoring Program Name
05. Institution
06. State (Abbreviation)
07. Certification Type
Clear selection
08. Payment Method
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy