ALPHA - AGENT REPRESENTATIVE APPLICATION

AGENT REPRESENTATIVE APPLICTION
COMPANY BACKGROUND
Alpha Account Manager*
Company Legal Name*
Company Trading Name*
ACN and ABN*
Address*
Website
Authorised Contact Person*
Contact number/s*
Email*
example@example.com
Student Service Regions*
Number of Years in Business*
Number of providers you currently represent*
Are you familiar with the requirements of the Australian ESOS Act and the Australian National Code 2018?*
Have any of your staff completed the PIER (Professional International Education Resources) - QEAC(Qualified Education Agent Counsellors) course?*
MARA License/PIER EATC Counsellor Certificate (if applicable)

Cancelof
REFEREES

Please list the contact details for two current referees
Referee 1
Company name
Contact person name
Contact person position
Phone number

Area CodePhone Number
Email address
example@example.com
Referee 2
Company name
Contact person position
Phone number
Email address
example@example.com
Privacy Notice
Alpha College of Australia is required to collect education agents' personal information. This may be shared with the Australian Government as required for the purposes of:
- promoting compliance with the ESOS Act and the National Code;
- assisting with the regulation of Agents;
- promoting compliance with the conditions of a particular student visa or visas, or of student visas generally; or
- facilitating the monitoring and control of immigration.
Information about education agents can also be accessed by all registered providers through PRISMS and includes:
- the outcome of enrolments
- the percentage of completed CoEs by the education agent
- the number of CoEs created with the education agent's involvement against the total number of CoEs created for the provider.
Education Agent Declaration
- I declare that the information provided is true and correct.
- I agree to the collection, use and disclosure of my personal information as per the Privacy Notice.
- I understand my responsibilities as an education agent under the National Code 2018 Standard 4 and have a good understanding of the international education system in Australia, including the International Education and Training Code of Ethics.
Name of education agent representative*
Education agent representative position*
Signature*

Clear
Date*

DayMonthYear
Date
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AGENT REPRESENTATIVE APPLICTION

COMPANY BACKGROUND

REFEREES

Referee 1

Referee 2

Privacy Notice

Education Agent Declaration