Education Agent Application Form

Following information about each of the agent’s employees (if any) who are involved in the agent facilitating the enrolment

Referees :
(Please provide details of at least two contactable referees from education providers you have been associated with)

Institutes/Universities :
(Please provide details of 2 Australian education providers you represent)

If yes, please provide names and cities

One of the key requirement of ESOS Act is that all providers on the Commonwealth Register of Institutions and Courses for Overseas Students (CRICOS) must maintain a list of all the provider's agents, and publish that list on its website. Imperial will be listing the names of education agents who recruit international students in Provider Registration and International Students Management System (PRISMS).
Imperial will be publishing the names of all its representatives on the website (www.imperial.edu.au) and will only deal with agents who consent to publishing their details on Imperial website.
By Signing this form you:

• consent to publishing your details on the Imperial website
• consent to listing your details on PRISMS

Our agent agreements includes a Privacy Statement as below:
Our appointed education agent agree to their personal information being: recorded in PRISMS. This may include their name, business email address, phone number and address; accessed by the Australian Government Department of Education, Department of Home Affairs and other Commonwealth agencies that access PRISMS; used to administer or monitor compliance with the Commonwealth legislation e.g. Education Services for Overseas Students Act 2000, Migration Act 1958; and disclosed by the Australian Government Department of Education to other Australian Government entities (including, but not limited to ASQA and TEQSA), education institutions and publically. The Australian Government Department of Education will share individual agents’ performance publically as aggregated data (but will not identify agent – provider relationships). Agent-provider relationships will only be identified when data is shared with education providers and other Australian Government entities.
By signing this application form, we declare that we will take reasonable steps to avoid conflicts of interests with our duties as an education agent of The Imperial College of Australia.