Change of Agent Nomination Form

Change of Agent Nomination Form
By Completing the Change of Agent Nomination Form, you are officially advising Winslow College of your intent to nominate an agent or new agent to represent you in your application to study at Winslow College.
Section 1 - Student Details
Name*

First NameLast Name
Student ID*
Email Address*
example@example.com
Phone Number*

Country CodePhone Number
Section 2 - Agent Details
Current Agent Company Name:
Contact Person:
Phone Number*

Country CodePhone Number
Nominated Agent Company Name:
Contact Person:
Phone Number*

Country CodePhone Number
Reason for Changing Agent:

Agent representative provided incorrect or misleading informationAgent representative is not responsive to my requestsOther (Please explain)
Student Declaration
Signature*

Clear
Date:

DayMonthYear
Date
Should be Empty:

Section 1 - Student Details