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Key Contact Information

Owner/General Manager

First Name

Last Name

Phone Number

Please enter the phone number starting with your country code

Email

Primary Contact

First Name

Last Name

Phone Number

Please enter the phone number starting with your country code

Email

Job Title

Other Contact #1 (if applicable)

First Name

Last Name

Phone Number

Please enter the phone number starting with your country code

Email

Job Title

Other Contact #2 (if applicable)

First Name

Last Name

Phone Number

Please enter the phone number starting with your country code

Email

Job Title

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Description of Core Business

Year Founded

Existing Number of Staff

Recruitment Area

Please select up to 4 target markets

Target Market 1	Target Market 2	Target Market 3	Target Market 4
OnshoreChinaEuropeJapanLatinMiddle EastSouth East AsiaSub-ContinentTurkeyOther	OnshoreChinaEuropeJapanLatinMiddle EastSouth East AsiaSub-ContinentTurkeyOther	OnshoreChinaEuropeJapanLatinMiddle EastSouth East AsiaSub-ContinentTurkeyOther	OnshoreChinaEuropeJapanLatinMiddle EastSouth East AsiaSub-ContinentTurkeyOther

If Other, please specify 'Other' regions:

How many students have you referred to Australian education institutions in the past 1 year?

Are there any judgments, orders against, proceedings, applications for winding up, dissolution, liquidation, or cessation of its business?

If Yes, please explain

Are you familiar with the ESOS act and the National Code 2018?

Which standards refer to Education Agents?

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References

Please provide three (3) references from Australian Education Providers that can vouch for your track record and your company’s financial standing.

Reference #1

First Name

Last Name

Phone Number

Please enter the phone number starting with your country code

Email

Company Name

Reference #2

First Name

Last Name

Phone Number

Please enter the phone number starting with your country code

Email

Company Name

Reference #3

First Name

Last Name

Phone Number

Please enter the phone number starting with your country code

Email

Company Name

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Supporting Documents

Please upload any relevant documentation to support your application (e.g. Business Profile, Agent Training Certificates etc.):

Supporting Statement

Supporting Document #1

Supporting Document #2

Supporting Document #3

Acknowledgement

By ticking this box I/we acknowledge that we do not consider submission of this application form as an appointment to act as an agent of Collarts. Subject to the successful assessment of this application by Collarts, I/we are prepared to enter into an engagement agreement with Collarts.

Date

Signee First Name

Signee Last Name

Signee Company

Signee Job Title