Agent online application

Company Details and Background

Company / Business Name:

Trading name (if different from Company name) :

Company/ Business Registration Number:

Years Established:

Name of Director/ CEO:

Town and Country of Company/ Business Registration:

Business Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Phone :

Website

Please describe your business activities

Number of staff:

Number of international offices:

Locations of International Offices:

Director and Employee Details

Person 1

Position :

Qualifications and previous experience:

Membership of education agent professional bodies:

Person 2

Name

Position

Qualifications and previous experience

Membership of education agent professional bodies:

Person 3

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 2017. 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?

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?

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

Are you willing to comply with the requirements of Medicus Collegeregarding advertising, course materials and application procedures, and provide accurate information to students?

Are you prepared to use the marketing materials provided by Medicus Collegeto promote our courses?

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

Position

Phone Number

Email Address

Dates when you worked with them

Institution 2

Name of Institution

Contact Person

Position

Phone Number

Email Address

Dates when you worked with them

Institution 3

Name of Institution

Contact Person

Position

Phone Number

Email Address

Dates when you worked with them

Declaration

Document

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.
Medicus Collegeis 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 Medicus Collegeis conﬁdential and is protected by the Privacy Act 1988 and other relevant legislation. Medicus Collegepolicy 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

Date

Printed Name

Document

Please return this form along with supporting evidence to Medicus College at the below address.

Address: 3/11 London Circuit Canberra ACT 2601 or email below:

Email: [email protected]

Company Details and Background

Director and Employee Details

Potential Markets and Services to be Provided

Agency Performance and Compliance

Additional Information

References

Declaration