Nomination of Agent form
This form is to be used by a Monash University applicant to nominate an approved Monash agent representative
to assist them with their course application, acceptance and student visa. Monash University has the
right to reject this agent nomination request depending on the services provided.
All sections MUST be fully completed by the Monash University applicant and not the
nominating Monash agent.
Please fax completed forms to International Recruitment Services +61 3 9903 4778
OR email to [email protected]
A confirmation email will be sent to the agent upon approval.
SECTION A: Student details
Student ID number
Course name
Student given name(s)
Family name
Student date of birth (dd/mm/yyyy)
Student address
Student contact phone number
Student email address
SECTION B: New agent details
Agent name
Agent address
Agent email
Agent fax number (please include country and area code) (
)
If you are changing your agent please indicate the reason why you are not satisfied with your current agent:
□ Not responsive to my requests
□ Provided wrong or misleading information
□ Other (please explain):
SECTION C: Student declaration
I (student name),
confirm that following agent will represent me:
(clearly print name of the new nominated agent)
By signing this form I also declare that I have completed the form myself and acknowledge that I or the agents nominated
may be contacted by Monash University for verification purposes.
Signature of student
Date