SC7.2-I: Education Agents Application Form

SC7.2-I: Education Agents Application Form
Company / Business Name: *

First NameLast Name
Trading name (if different from Company name) *
Company/ Business Registration Number: *
Years Established: *

MonthDayYear
Date
Name of Director/ CEO: *

First NameLast Name
Town and Country of Company/ Business Registration: *
Business Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Website*
Please describe your business activities *
Number of staff*
Number of international offices*
Locations of International Offices*
Director and Employee Details

Person 1
Name*

First NameLast Name
Position*
Qualifications and previous experience*
Membership of education agent professional bodies: *
Director and Employee Details

Person 2
Name

First NameLast Name
Position
Qualifications and previous experience
Membership of education agent professional bodies:
Director and Employee Details

Person 3
Name

First NameLast Name
Position
Qualifications and previous experience
Membership of education agent professional bodies:
Potential Markets and Services to be Provided
What are your target markets? *
What marketing strategies will you use to promote our courses? *
Please outline any support services that you offer prospective students*
Do you charge students any fees for your service? If YES, please provide details of the services and relevant fee for each.
Agency Performance and Compliance
How many Australian education institutions are you currently representing? *
How many students have you referred to Australian educational institutions in the past 2 years? *
Please briefly outline how you and your organisation will fulfil your responsibilities as an education agent as required by the National code 2018. Please attach additional information such as company flyers etc. if required.*
Have you or any of your staff completed the Education Agents Training Course (EATC) available through www.pieronline.org?

YesNo
If YES, please list who has completed the course
Do you have a comprehensive understanding of the requirements of the ESOS Act and National Code?*

YesNo
Do you regularly monitor the Australian Department of Immigration and Citizenship (DIAC) website (www.immi.gov.au) and the Department of Education*

YesNo
Are you willing to comply with the requirements of Level Up Education and Training Academy regarding advertising, course materials and application procedures, and provide accurate information to students?*

YesNo
Are you prepared to use the marketing materials provided by Level Up Education and Training Academy to promote our courses?*

YesNo
Additional Information
Please provide any other information that you think will support your application. *
References

Please provide details of at least 3 Australian educational institutes that we can contact for a reference.
Institution 1
Name of Institution *
Contact Person *

First NameLast Name
Position*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Dates when you worked with them *
Institution 2
Name of Institution *
Contact Person *

First NameLast Name
Position*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Dates when you worked with them *
Institution 3
Name of Institution *
Contact Person *

First NameLast Name
Position*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Dates when you worked with them *
Declaration
In signing this agreement, you declare that:
- You have read and understood the extract from the ESOS Act 2000 Obligations of Agents.
- The answers and details provided in this application are true, accurate and complete.
- Level Up Education and Training Academy is authorised to contact the referees listed to collect information about my conduct and services.
- You acknowledge and agree to the privacy statement provided below.
Privacy Statement: All information collected, used or disclosed by Level Up Education and Training Academy is conﬁdential and is protected by the Privacy Act 1988 and other relevant legislation. Level Up Education and Training Academy policy is outlined in the Information Privacy Policy available from our website. Information about Agents or students may be made available to Commonwealth and State agencies if required to provide the information by law.
Signature*

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Date*

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Date
Name*

First NameLast Name
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SC7.2-I: Education Agents Application Form

Director and Employee Details

Director and Employee Details

Director and Employee Details

Potential Markets and Services to be Provided

Agency Performance and Compliance

Additional Information

References

Declaration