International Agent Application Form

Company Details

What is your organisation name? *

Please enter your org name

When was your company established? *

Enter the 1st of January and the year company established if you can't remember the exact date

Organisation Phone *

Pick a country (by selecting flag), then enter your organisation phone number

Address line 1 *

Address line 2

Address line 3

Town/City *

County/State

Postcode/Zip Code

Country *

Contact first name? *

Please enter your first name

Contact last name? *

Please enter your last name (family name or surname)

What is your role?

Please enter your role

What is your email? *

Please enter your email

Mobile Number *

Pick a country, then enter your phone number

Main three destinations of your students *

Numbers sent to UK (all institutions) every year *

If no historic data, please estimate

Brief Description of your company. How do you recruit international students and the main age range? Which courses do they normally choose in UK? Do you also use sub-agents? *

Use the above space to give us a bit more information about you.

References

Please provide details of two educational organisations with who would be happy to provide a short reference to support your registration. These should be educational institutions or business partners. We will ask the referees to answer the following questions:

How long have you worked with this company?
Have you been satisfied with the working relationship?
Have you experienced any problems with payment or visa support?
Would you recommend this company to other organisations?
Do you have any further comments?

If you have any questions about this, please don’t hesitate to contact us at international@ucleeds.ac.uk - we will always work with you when taking up references.

Referee 1: Name of institution *

Referee 1: Name of contact *

Referee 1: Telephone

Referee 1: Email

Referee 1: Address

Please include country

Referee 2: Name of institution *

Referee 2: Name of contact *

Referee 2: Telephone

Referee 1: Email

Referee 2: Address

Please include country

Declaration *

I agree

By completing this form, I confirm that the information provided is correct to the best of my knowledge, and I have the authority to represent the company named above.