Education Agent Reference Check Form

Education Agent Reference Check Form
Agent Location (Country)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Agent Organisation Name*
Referee Details
Organisation Name*
Phone Number

Country CodePhone Number
Contact Person*
Address*
Email*
example@example.com
How long has the agent been associated with your organisation for?*
How many students has the agent enrolled with your organisation (approx.)?*
How many students from these were cancelled with your organisation (approx.)? *
What are the services that the agent provides to your institution?*
Are there any complaints from students or other agents about this agent?*

YESNO
If YES, please specify below
Accurate and ethical marketing information provided by the agent about courses offered, fees, refund policy etc.*

YESNO
If NO, please specify below
Would you recommend us to collaborate with this agent?*

Highly RecommendedRecommendedNot Recommended
Are you satisfied with the quality of this agent’s work? Please rate on a scale of 1-5, with 1 being ‘Unsatisfied’ and 5 being ‘Very Satisfied’.*

12345
Any additional Comments
I confirm all the information given is correct and that there is no conflict of interest in providing this reference.
Signature*

Clear
Date

DayMonthYear
Date
Should be Empty:

Referee Details