Agent Application - UCI International Programs

Full Legal Name of Agency*

Country*

Phone*

Fax

Type of Business*

Corporation

Individual/Sole Proprietorship

Limited Liability Company

Partnership

Website

Where did you hear about us?*

Primary Contact Name*

Prefix First Last

Title*

Email*

Mailing Address*

What year was your agency established?*

Please enter a number from 0 to 2100.

From which countries do you recruit students?*

How do you market your services and promote institutions that you represent?*

Please select all of the programs you believe you will be successful in identifying and sending qualified applicants to:*

English Language (ESL)

Professional Certificates (ACPs) & Internship

Success Through Academics and Research (STAR)

Academic Study Abroad (ASAP)

Master of Laws (LL.M.)

Experience University Research (EUR)

Experience University Research Online Law

Online Programs and Courses

What services do you provide to students?*

Do you charge a service fee to students?*

Yes

If yes, how much do you charge?

Do you have any offices in the United States*

Yes

How many students have you sent to U.S. institutions within the last 12 months?*

Please enter a number from 0 to 100000.

How many students do you expect to send to UCI annually?

Number of Staff*

Please enter a number from 0 to 99999.

Number of Offices*

Please enter a number from 0 to 99999.

Is there anything else you would like us to know?

References

Reference checks are an important part of our assessment process. Please provide three references for academic institutions (preferably based in the U.S.) you currently work with.

Reference #1

Institution Name*

Contact Name*

Email*

Reference #2

Institution Name*

Contact Name*

Email*

Reference #3

Institution Name*

Contact Name*

Email*

UCI Division of Continuing Education (DCE) adheres to and expects agents representing our programs and students to adhere to NAFSA’s Statement of Ethical Principles. By signing the following, you and all representatives of your agency agree to abide by and adhere to the Statement of Ethical Principles as outlined by NAFSA. Failure to adhere to these principles may result in DCE’s terminating its relationship with the agent.

Do you agree to abide by and adhere to the Statement of Ethical Principles as outlined by NAFSA?*

Yes, I do.