Agents Applications Form
1. COMPANY DETAILS AND BACKGROUND
Business Legal Name:
Trading Name (If different from legal name):
Company/Business Registration Number:
Year Established:
Town and Country of Registration:
Business Address:
City:
Suburb/State:
Country:
Postal Code:
Phone:
Format: (000) 000-0000.
Number of staff:
Email:
example@example.com
Website:
Number of international offices:
Locations of International Offices (if applicable):
Please describe your business activities:
2. DIRECTOR AND EMPLOYEE DETAILS
Person 1
Person 2
Name:
Name:
Position:
Position:
Qualifications and previous experience:
Qualifications and previous experience:
Membership of education agent professional bodies:
Membership of education agent professional bodies:
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3. POTENTIAL MARKETS AND SERVICES TO BE PROVIDED
What are your main target markets?
Marketing strategies will you use to promote courses?
Any support services that you offer:
Do you charge students any fees?
Yes
No
If YES, please provide details?
4. AGENCY PERFORMANCE AND COMPLIANCE
How many Australian education institutions are you currently representing?
Number of students referred to Australian Institution in past 2 years:
Have you or any of your staff completed the Education Agents Training Course (EATC) available through www.pieronline.org?
Yes
No
If YES, please list who has completed the course.
Do you have understanding for the requirements of the ESOS Act and National Code?
Yes
No
Do you regularly monitor the Department of Home Affairs DHA website?
Yes
No
Are you willing to comply with the requirements of Heaton Institute of Technology regarding advertising, course materials and application procedures to provide accurate information to students?
Yes
No
Are you prepared to use the marketing materials provided by Heaton Institute of Technology to promote our courses?
Yes
No
Additional Information: Please provide any other information that you think will support your application.
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5. 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:
Position:
Phone Number:
Format: (000) 000-0000.
Email Address:
example@example.com
Since when you worked with them:
Institution 2
Name of Institution:
Contact Person:
Position:
Phone Number:
Format: (000) 000-0000.
Email Address:
example@example.com
Since when you worked with them:
Institution 3
Name of Institution:
Contact Person:
Position:
Phone Number:
Format: (000) 000-0000.
Email Address:
example@example.com
Since when you worked with them:
6. DECLARATION
By 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.
Heaton Institute of Technology 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 Heaton Institute of Technology is confidential and is protected by the Privacy Act 1988 and other relevant legislation. Heaton Institute of Technology 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:
Name:
Date:
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Month
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Day
Year
Date
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