Agent Application Form
(Fill in all fields with an * asterisk)
* Company/business name
* Name of company director
* Name of the main contact in your company for correspondence
* Telephone number #1
* Primary contact - email
Additional contacts - email
* How many years has the agency been established?
Do you have branch offices
(If yes, please indicate the address and contact information including contact name, email and telephone numbers.)
Why do you want to work with NYEC
* How did you hear about us?
* How many staff do you have offering programs?
* Methods of counselling? To select more than one option press Crtl
What kind of clientele do you mostly cater to?To select more than one option press Crtl
* Please select up to 3 types of courses most frequently booked by your students? To select more than one option press Crtl
In the last 12 months, how many students did you send to an educational institution?
In the next year, how many students do you expect to send on programs?
Do you produce your own brochures?Yes No
Have you seen our newest brochure?Yes No
Further information about your agency
Which other schools do you work with?
Please provide us with two references, at least one of which must be a Language School/University functioning in the education field and you have/are working with? NYEC the referees to verify this information