Agent Representative Application

Agency Name*
Primary Address*
Primary Address Primary City Primary Province/State Primary ZIP/Postal Code Country
Primary Office Phone Number*
General Office Email*

When was your company founded?*
Please enter a number from 1900 to 2080.
Number of Employees?*
Please enter a number from 1 to 20000.
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
Rank the top three (3) countries you recruit students from.*

Do you recruit students for other public school districts in Canada?*
- Yes
- No
Rank the top three public school districts and private institutions you current recruit students for:*
Last year, how many total students did you send overseas?*
Please enter a number from 0 to 100000.
How many students studied in Canada?*
Please enter a number from 0 to 100000.
How many students did you send for long term public secondary school study? (2 semesters or more)
How many students did you send for short term public secondary school study? (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 High School Programs (CVISP), how would you market and promote our programs in your recruitment area?

Please list 2 references that we should contact to learn more about your organization:
Institution*
Primary Address*
Primary City Primary Province Country
Primary Contact Name*
First Last
Primary Contact Email*
Institution*
Primary Address*
Primary City Primary Province Country
Primary Contact Name*
First Last
Primary Contact Email*
Upload your company profile [Optional]
Company Profile
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Please list 2 references that we should contact to learn more about your organization: