Thank you for your application to become an Education Agent
for Envirotech Institute of Education
Agent Application Form
This application is to be completed by prospective agents as a request to be considered as Envirotech’s
approved representative. This is in addition to the online application you will have to complete on Envirotech
website. After completing this form, Envirotech will evaluate your request and provided information, in
compliance with the required criteria and standards. Completion of this Application does not necessarily mean
that you will automatically receive an agent agreement. Please make sure you complete the application in full
and response to questions in details. Envirotech’s contract administrator is here to support you in your
application to become Envirotech’s agent.
Please feel free to contact us via email: [email protected]
1. Agency Details
Agency Name
Years operated
Number of staff and counsellors
Location of any additional Australian and
International Offices
Number of offices
Your main recruitment countries in the last 5 years
Countries where you will invest the most of your
marketing efforts during the current and next
financial years
The overseas Australian DIBP office you have most
your visas submissions
2. References Check (2 Contact Persons Required)
Education Agent/Contact person (1)
Position
Phone Number
Email
No. of Years working with this agent
No of student enrolled with this agent
Education Agent/Contact person (2)
Position
Phone Number
Email
No. of Years working with this agent
No of student enrolled with this agent
3. Declaration
I declare that I have read and understood the extract from the ESOS Act 2000 and National Code –
Obligations of Agents. The answers and details provided in this application are true and accurate to the best
of my knowledge and I authorize the College to approach referees to collect any information or details as the
College may require.
Applicant Full Name
Applicant Signature
Applicant position
Date
Witness Full Name
Witness Signature
Witness position
Date
4. Agents Application Documents Checklist
Please attach copies of the following:
1.
2.
3.
4.
5.
☐ Company/business registration certificate
☐ List of educational providers currently representing
☐ Agents’ qualification certificates
☐ Marketing materials and any other relevant supporting information
☐ This signed declaration form
Privacy Policy: All personal information collected, used or disclosed by the College is confidential and is
protected by the Privacy Act 1988, the Information Privacy Act as amended by the Privacy Amendments
(Enhancing Privacy Protection) Act 2012 and other relevant legislation. Information about Agents or students
may be made available to Commonwealth and State agencies if requested.
Thank you for your application to become part of our marketing and students’ recruitment team. I look forward
to assisting your agency in becoming an active partner and enjoy fruitful synergy.
Sincerely,
Regina Frolova, Contract Administrator