Education Agent Application Form

Details


Section 1: Company Description

Please provide an overview of the key personnel within your company: (Attach additional pages as required)


Section 2: Key Personnel

Please provide an overview of the key personnel within your company: (Attach additional pages as required)


Section 3: General


Section 4: Referees (Please provide 2 referees)

Referee 1


Referee 2


Section 5: : Company Portfolio

Which Universities/ Colleges/Institutes do you currently represent in Australia?

What year did you start representing the institution?


What year did you start representing the institution?


What year did you start representing the institution?


What year did you start representing the institution?


What year did you start representing the institution?


Declaration

I declare that I have read an understood the extract from the ESOS Act 2018 – Obligations of Agents and that the answers and details provided in this application are true and accurate to the best of my knowledge and I authorise the Institute to approach referees to collect any information or details as the Institute may require.

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Leaders Institute Pty Ltd T/A Leaders Institute
ABN : 99 605 807 305
Phone : +61 (07) 3161 5566
76 Park Road, Woolloongabba
Brisbane, Queensland, 4102, Australia
Email: info@leaders.edu.au