Change of Agent Nomination Form

CHANGE OF AGENT NOMINATION FORM
Instructions
- By completing the Change of Agent Nomination Form, you are officially advising Auscanus Institute of Australia your intent to nominate an agent or new agent to represent you in your application to study at Auscanus Institute of Australia.
- This form is to be used for students who have been enrolled full time by Auscanus Institute of Australia and who are applying for a change of the existing enrolment.
- Incomplete forms will not be accepted.
- Accurate information must be provided for the College to assess the application and correspond to student.
Section 1 - Student Personal Details
AIA Student ID*
Name*

Family NameGiven Name
Current Campus*
Current Course*
Mobile Number*
Email address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Section 3 - Student Declaration
- I declare that the information supplied by me on all parts of this form is correct and true.
- I declare that I would like to nominate the above agency to represent me in my application to study at Auscanus Institute of Australia.
I, an student of AIA declare,

That the information supplied by me on all parts of this form is correct and true.That, I would like to nominate the above agency to represent me in my application to study at Auscanus Institute of Australia (AIA).
Student Name*
PRINT FULL NAME
Student Signature*

Clear
Date*

DayMonthYear
Please verify that you are human*
Should be Empty:

CHANGE OF AGENT NOMINATION FORM