Education Agent (EOI & Recruitment) – Application Form Company Background 1. Organisation Details TitleMrMrsMissMsDrProf Other Offices 2. Please provide all other office locations (if operating more than one); addresses, details for each staff member and key contact person for each location Education & Bussiness 3. List few Education Providers Your Company Represents* 4. List countries that your company recruits students* 5. Number of years in business as a Student Education Agent 6. List the countries (including any overseas locations) where you have contacts/operate and are interested in representing/sourcing students i.e. recruit potential students to Leeds* IndiaAustraliaUnited Arab EmiratesUnited States of AmericaAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustriaAzerbaijanBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBritish Virgin IslandsBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDemocratic Republic of the CongoDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaeroe IslandsFalkland IslandsFederated States of MicronesiaFijiFinlandFranceFrench GuianaFrench PolynesiaGabonGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedonia (FYROM)MadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorth KoreaNorthern IrelandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRepublic of the CongoReunionRomaniaRussiaRwandaSaint BarthelemySaint Kitts and NevisSaint LuciaSaint MartinSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaScotlandSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSouth SudanSpainSri LankaSt Pierre and MiquelonSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandThe BahamasThe GambiaTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited KingdomUruguayUS Virgin IslandsUzbekistanVanuatuVatican CityVenezuelaVietnamWalesWallis and FutunaYemenZambiaZimbabwe Any Judgement 7. Are there any judgments, orders or proceedings against your company, application for its winding up, dissolution, liquidation or cessation of its business? NoYes Director’s Details 8. Details of Business Owner / Director(s) background, qualifications and previous experience* Referees 9. Please list the names of two (2) relevant and independent referees (preferably established education providers) who can confirmyour track record and your company’s financial standing* Referee 1 Referee 2 Other Information 10. Please use the space provided below to include any other information you consider to be of importance to this application. Information must include a brief business plan outlining proposed student recruitment activities and target number of students you are planning to recruit for Leeds. To support your application, any supplementary documents should be included with this Application Form* Attachments 11. Please ensure the following supporting documents have been attached – Business Profile and Copy of Business Registration Certificate as issued by the relevant government department in your country. Failure to supply these two required documents will result in delay of the application being processed Supporting document attachments (maximum size 10MB) should be in any one of these formats:.doc; .docx; .pdf; .jpeg; .png; .rtf; .txt; .gif Certified copy of Business Registration* Company Profile/Business Plan including annual marketing initiatives* Any Additional Comments/Attachments Bank Account Details 12. Bank Account Details Representatives/Referral 13. Name of Leeds Representative or Account Manager with whom you have exchanged communication or been in contact * Proposed Agreement & Declaration 14. I Acknowledge That Approval Of This Application Is Conditional Upon My Company Entering Into An Agreement With Leeds.I Confirm That The Answers And Details Provided Are True And Accurate To The Best Of My Knowledge. I Authorize Leeds To Contact The Referees To Collect Any Information As Required From Time To Time. Signature* Please Sign in the box Reset Form
