ACADEMIC PARTNERSHIP & COLLABORATION INFORMATION REQUEST

ACADEMIC PARTNERSHIP & COLLABORATION INFORMATION REQUEST

Please have a photocopy of your ID, Company Registration (If applicable) (PDF, JPEG or PNG) available on your mobile phone, laptop, desktop or tablet before you proceed with the registration process. Upon completion of this application form the applicant will be directed to the EDUVISA Payment Gateway for seamless EFT or Debit/Credit Card payment options or alternatively will receive a system-generated Invoice with the appropriate payment instructions. Please complete all the sections of the application to proceed with the application process.
Name and Surname of Applicant*

Name Surname
ID Number*
ID Number of Applicant
Birth Date*

DayMonthYear
Upload Proof of ID (PDF / Image)*

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Current Age*
Gender*
Take Photo via Cellphone / PC / Tablet*
Personal Address*

Street Address

Street Address Line 2

Town / CityCounty / State / Province

Zip CodeCountry
Applicant E-mail*
Email to be used for all correspondence
Cellphone / Mobile Number*

Country CodeArea CodePhone Number
Name of Company / Organisation that will register as EDUVISA Academic Partner (ASC / ALC)*
Upload Proof of Registration of the mentioned Company / Organisation (PDF / Image)

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Upload Logo of Company / Organisation (PNG) for online branding purpose

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Upload of Photos of the Venue / Premises that will be used as Centre*

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Official Email to be used for Centre / Campus*
Example@example.com
Telephone Number to be used for Centre / Campus*

Country CodeArea CodePhone Number
Address to be used as EDUVISA Accredited Student / Leadership Centre *

Street Address

Street Address Line 2

Town / CityCounty / State / Province

Postal / Zip CodeCountry
Estimated Number of Students that will be referred by your institution to EduVisa in Year 1*
Estimated Number of Students that will be referred by your institution to EduVisa in Year 2*
Should be Empty: