Become a register Agent

AGENT APPLICATION FORM

COMPANY

Agent/Agency (Legal Name) Trading Name Business/Mara/ Registration Number: ABN/ACN

CONTACT DETAILS

Title Given Name Family Name Possition

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Years as an education agent

Number of years

Has the company or any individual within the company ever been involved in past, pending, threatened or potential litigation, arbitration, administrative actions or other disputes?(Required)

Yes

Have you or your staff completed the EATC Training (PIER Online)? http://www.pieronline.org/eatc/(Required)

Yes

If yes, please provide details:

No. of students recruited to Australian Institutions each year?

Please list the popular courses amongst your students:

How do you intend to promote International Technical Institute (ITI) in your office?

How many students do you intend to recruit to ITI each year?

No of staff:

List member of Associations:

Services provided to students:

Number of offices (locations):

(If you have other office(s), please send email list of offices to marketing@iti.edu.au if more than one)

Do you recruit students to countries other than Australia, If yes, please list below

Do you represent educational institutions in Australia? If yes, please list below:

Section Break

Reference 1

Contact Name Organisation Position

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference 1

Contact Name Organisation Position

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Organisational Chart: (If available, please attach)

Max. file size: 64 MB.

Business Profile/Strategic Plan (If available, please attach)

Max. file size: 64 MB.

FULL NAME OF THE PERSON AND ROLE(Required)

CAPTCHA

Date(Required)

Become a register Agent

AGENT APPLICATION FORM

Section Break

info@iti.edu.au

+61 3 7044 7785

Contact us

Head office: Suite 2, Level 15, 190 Queen Street, Melbourne VIC 3000

Workshop: 38 Steel Street, North Melbourne VIC 3051