Prospective Agent Application

Company Details

Name of Company

Headquarter's Permanent Address

Country

Street

City

Region

Postal Code

If your company has branch locations, please upload a document listing your branch locations.

Company Website

Company Phone Number

Company WhatsApp Number

How many employees do you have?

Contact Information

Please complete this section with information for the person who will be UW-Eau Claire's primary point of contact during the agent application and contract process.

Prefix

First Name

Last Name

Job Title

Email Address

Office Phone Number

WhatsApp Number

Agency Certifications / References

Does your agency have any certifications from either ICEF or AIRC?

Yes

Because your company is not AIRC or IECF certified, we require reference checks. Please enter information for three references below from colleges/universities you are partnered with.

Reference #1

First Name

Last Name

Email Address

University / College Name

University / College Address

Country

City

Region

Please provide information about your partnership with this individual and institution: How long you've worked with them, how many students you've sent to the university, which countries students have come from, etc.

Reference #2

First Name

Last Name

Email Address

University / College Name

University College Address

Country

City

Region

Reference #3

First Name

Last Name

Email Address

University / College Name

University College Address

Country

City

Region

Recruitment Information

Please use the fields below to list the primary country or countries (up to ten) that you primarily recruit from, and the major cities within those countries.