The Leadership College of Australia RTO: 52856

Company / Business Name *

Trading name (if different from Company name)

ABN *

Migration Agency Number (if applicable)

Years Trading as Education Agent

Name of Director/ CEO *

Country of Company/ Business Registration

Business Address *

Phone *

Email *

Website *

Please describe your business activities

Number of staff

Number of international offices

Locations of international offices

Person 1

Name *

Position

Phone *

Email *

Person 2

Name *

Position

Phone *

Email *

What are your target markets?

What marketing strategies will you use to promote our courses?

How many Australian education institutions are you currently representing?

How many students have you referred to Australian educational institutions in the past 2 years?

In regards to fulfilling our responsibilities as an education agent as required by the National Code 2018.

Have you or any of your staff completed the Education Agents Training Course (EATC) available through www.pieronline.org?YesNo

If YES, please list who has completed the course.

Do you have a comprehensive understanding of the requirements of the ESOS Act and National Code?YesNo

Do you regularly monitor the Australian Department of Immigration and Citizenship (DIAC) website (www.immi.gov.au) and the Department of Education?YesNo

Are you willing to comply with the requirements of our RTO regarding advertising, course materials and application procedures, and provide accurate information to students?YesNo

Are you prepared to use the marketing materials provided by our RTO to promote our courses?YesNo

Please provide any other information that you think will support your application

Please provide details of at least 2 Australian educational institutes that we can contact for a reference.

Institution 1

Name of Institution *

Contact Person *

Position

Phone *

Email *

From Date *

To Date *

Institution 2

Name of Institution *

Contact Person *

Position

Phone *

Email *

From Date *

To Date *

ABN or ACN Certificate (if applicable)

Business Profile *

PIER (or MARA) Certificate *

Attach Flyers

By submitting this agreement form, you declare that

• You have read and understood the extract from the ESOS Act 2000 Obligations of Agents.

• The answers and details provided in this application are true, accurate and complete.

• The Leadership College of Australia is authorised to contact the referees listed to collect information about my conduct and services.

• You acknowledge and agree to the privacy statement provided below.

Privacy Statement: All information collected, used or disclosed by The Leadership College of Australia is confidential and is protected by the Privacy Act 1988 and other relevant legislation. The Leadership College of Australia policy is outlined in the Information Privacy Policy available from our website. Information about Agents or students may be made available to Commonwealth and State agencies if required to provide the information by law.

Signature *

I Accept