AGENT APPLICATION FORM

    All fields are mandatory. Please write in English using BLOCK LETTERS and tick where applicable.


    AGENCY DETAIL

    AGENCY PRINCIPAL CONTACT PERSON

    Name:

    Name:

    ABN/ACN

    (if applicable):

    Position:

    Facsimile:

    Email:

    Phone Number:

    Phone Number:

    Website:

    AGENCY CONTACT PERSON FOR FINANCE MATTER


    Address:

    Name:

    Email:


    COMPANY BACKGROUND

    COUNSELLORS DETAILS

    The year of establishment of your company:

    Number of Education Counsellors:

    Specialist in:

    VETHigher EducationHigh SchoolELICOS

    Principal Counsellor:

    Main regions of Recruitment:

    Number of years of experience of Principal Counsellor in the Education industry:  

    Number of successful applications in past 12 months:

    Number of counsellors affiliated with PIER, ICEF or similar industrial body (please provide individual accreditation number):

    Please list 4 institutions that you are currently representing:

    1.

    2.

    3.

    Number of Registered Migration Agent (please provide individual MARN):

    4.

    Please list all the support services that you offer to prospective students:


    REFERENCES - Please list two institution-contacts that we can contact for reference.

    Reference 1

    Reference 2

    Contact Person:

    Contact Person:

    Position:

    Position:

    Organisation:

    Organisation:

    Email:

    Email:

    Phone:

    Phone:


    DECLARATION


    1. Can you ensure that your agency regularly conducts the following actions?

    • Monitor regulations and/or any changes as released on the website of Department of Home Affairs (DHA).

    • Implement, monitor and work in accordance with the National Code of Practice for Providers of Education and Training to Overseas Students 2018 and ESOS Act (Regulations) 2019.

    • Monitor policies and/or any changes as released on the website of Department of Education and Training.

    • Only to use the materials supplied by Melbourne College of Business and Technology in any of the promotion activities.

    • Yes      No


    2. Has anyone in your agency ever:


    • ♦    Been refused any registration under any law of any country?

    • Yes      No

    • ♦    Engaged or been charged with any offence/activity that subject to any statutory penalty or sanction in any country?

    • Yes      No

    • ♦    Engaged in or to have previously been engaged in, dishonest practices, including:

      •     ♣     Deliberately provide misleading or unfounded information, or bogus document to any student, education provider, government authority or other organisation,

      •     ♣     Facilitate the enrolment of a student who will not comply with the conditions of their student visa

      •     ♣    Provide unethical advice to any stakeholders

      •     ♣    Provided immigration advice when not authorised to do so under the Migration Act 1958?

    • Yes      No


    3. Do you have an internal policy to assess whether the prospective client is a genuine student?

    • Yes      No

    If Yes to any of above statement, please provide details:



    I am interested in representing Melbourne College of Business and Technology as an educational agent.
    I confirm that all information stated in this Agent Application Form is true and accurate.

    I consent to Melbourne College of Business and Technologycontacting any of the referees I have stated in this form.

    I understand that if my application for an Agency of Melbourne College of Business and Technology is successful, I will be required to enter into and abide by a formal Agency Agreement.

    SIGNATURE:    

    POSITION:    

    PRINT NAME:    

    DATE:    

    CHECKLIST AND SUBMISSION


    Please forward above documentations to: ATTN: Marketing Manager

    Melbourne College of Business and Technology Unit 101, 991 Whitehorse Road,

    Box Hill, Victoria, 3128 Australia

    Or

    Email to enquiry@mcbt.vic.edu.au .