EDUCATION AGENT APPLICATION FORM

Please select the College(s) for which you have submitted an application: *

Legal Business Name

Trading Name

Country of Company Registration

Date of Initial Registration

Head Office Address

Company Website

Contact Person Name

Overseas registration number

Contact Person Position

Contact Person Email Address

Contact Person Phone Number

How many years has the contact person worked in International Education

Full name(s) Company Director(s)

Have any of the company directors ever been convicted of a criminal offence, or been subject to any banning, disqualification, or enforcement action by a regulatory body (including ASQA, TEQSA, or any state regulator)?

YesNo

Have / are any of the directors currently / previously been a director, owner, or key person of any other registered training organisation or education provider?

YesNo

If yes, please provide details.

Key Personnel 1

Name

Position

Email

Phone Number

International education related certifications

Key Personnel 2

Name

Position

Email

Phone Number

International education related certifications

Does your company employ Registered Migration Agent(s) (RMA)

YesNo

If yes, please provide their MARN(s)

Does your company employ QEAC (Qualified Education Agent Counsellor)?

YesNo

If yes, how many?

Is your company a member of any professional associations (eg. ISEAA, AAERI, ITECA, ICEF, PIER etc.)?

YesNo

Association Name:

Membership Number:

Does your company have formal agreements with other Australian education institutions?

YesNo

If yes, how many current, formal education agreements do you have?

In the previous 12 months, how many students have you referred to Australian education institutions under your formal education agreements?

Have you ever had an education agent agreement terminated by any institution?

YesNo

If Yes, please provide details:

Does your company operate franchises?

YesNo

Please nominate the Business Names and ABNs for the franchise operations we may expect to receive applications from?

Does any person associated with your business (including directors, officers, employees, contractors, family members, or related entities) have any ownership, control, beneficial interest, or family / business connection with any other CRICOS-registered provider?

YesNo

If Yes, please provide details (CRICOS provider name and code, nature of the connection, and the person(s) involved):

Please Provide 2 Referees (Contacts Of Two Other Training Providers You Represent)

Reference Person 1

Education Institution Name

Contact Person Name

Contact Person Position

Email

Phone Number

How many students did you refer to this Education Institution in the previous 12 months?

Reference Person 2

Education Institution Name

Contact Person Name

Contact Person Position

Email

Phone Number

How many students did you refer to this Education Institution in the previous 12 months?

Bank

Account Name

BSB (Australian bank accounts only)

Account Number

Swift Code

Business registration documents

MARA Certificate

QEAC Certificate

Other Doc.

Name & Position

Signature Format

Pen Eraser

Sign Date

The Pacific	North Asia (including Japan and Korea)	Europe
South East Asia	Middle East	LATAM
China	UK	Other
Central Asia

Education Agent Application Form

Key Personnel 1

Key Personnel 2

Reference Person 1

Reference Person 2

Performance Monitoring Agreement

Training and Development

Quality Assurance