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AGENT APPLICATION FORM

Portugal Coast

Step 1 of 5

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Agency Name*
Where is your office located?*
Street City Province/State ZIP/Postal Code Country
Office Phone Number*
General Office Email*
Agency Website*
Marketing Countries*
Where does your agency recruit students from? Select all that apply.
- Argentina
- Austria
- Belgium
- Brazil
- Chile
- China (People's Republic of)
- Colombia
- Czech Republic
- Egypt
- El Salvador
- France
- Germany
- Hong Kong
- Italy
- Japan
- Korea (The Republic of)
- Mexico
- Philippines
- Poland
- Portugal
- Romania
- Spain
- Switzerland
- Taiwan (Republic of China)
- Thailand
- Turkey
- Vietnam
- Other

Agency Details
Invoicing preference.*
NET invoicing is best for partners who collect fees payments directly. GROSS invoicing is best for partners who do not collect any fees and wish to invoice for commission.
- GROSS
- NET
*
Year your Agency founded Number of Employees
What is your company's primary business activity?*
Describe the kind of experience your employees have recruiting students for Canadian public secondary institutions:*
Do you recruit students solely for Canadian Institutions?*
- Yes
- No
Do you currently have active partnerships with other Canadian educational institutions?*
- Yes
- No
Please list your top three Canadian Partners.*
District / Institution Province / City
Study Destination*
How many students did you send overseas? How many students studied in Canada?
Lengths of study*
How many students enrolled Long-Term (2 semesters or more) How many students enrolled short-term (2 weeks to 1 semester)
Do you send short term ESL groups?*
- Yes
- No

Describe the services you provide to students before, during and after their period of study overseas:
If you were to become an Authorized Representative of the Comox Valley International Program, how would you market and promote our programs in your recruitment area?

Staff & Contact Informtion
Agency Signing Authority*
List the person who is your authorized signatory / who will be signing this partnership agreement
First Name Last Name Position Gender Phone Email
Additional Agency Contacts*
List all additional staff who would be in contact with our office or who would require profiles set up on our Secure Portal.
First Name Last Name Position Gender Phone Email

References
List up to three (3) public school districts or private institutions that will provide references:*
District/Institution City/Province Contact Name
Upload your company profile [Optional]
Company Profile
Accepted file types: pdf, doc, docx, ppt, pptx, xls, xlsx, epub, odt, odp, ods, txt, rtf, Max. file size: 10 MB.
Please upload one of the following formats: PDF, DOC, DOCX, PPT, PPTX, XLS, XLSX, EPUB, ODT, ODP, ODS, TXT, RTF
Email
This field is for validation purposes and should be left unchanged.

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Comox Valley International Student Program

2085 Wallace Ave.
Comox, BC, Canada, V9M 1W4

Phone: 1 250 703 2904
Email: isponline@sd71.bc.ca

Language

Chinese (Simplified)

Chinese (Traditional)

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