Agent Application

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Data Collection, Use and Consent

This application form collects private information about you so that we can determine the type of homestay environment you offer and the features that may be of interest to prospective students. Your consent is required.

Confirmation of Consent

I consent to the collection and use of my private data by First Choice International Placement Inc. in accordance with their privacy policy.

Primary Contact Information

Agency Representative's Full Name

First

Last

Agency Representative's Position

Agency Representative's Phone

Agency Representative's Email

Confirm Email

Historical Information

Provide a brief history of your agency

Has the company or any individual within the company ever been involved in past, pending, threatened or potential litigation, arbitration, administrative actions or other disputes?

Does the company currently have or is the company expecting to have permanent staff residing in Canada who will provide direct service and support to your students?

Primary Geographic Focus

Agent Motivation

Briefly explain why an agent agreement with us is important:

Reference Information

Reference #1 (Canadian School, College or University Representative)

Name of Educational Institution

City Where Institution Is Located

Institution Representative's Name

Institution Representative's Position

Institution Representative's Email

Institution Representative's Phone

Reference #2 (Other)

Company/Organization Name

City Where Company/Organization Is Located

Company/Organization Representative's Name

Company/Organization Representative's Position

Company/Organization Representative's Email

Company/Organization Representative's Phone

Declaration of Intent and Accuracy

If approved as an agent for First Choice International Placement Inc. I am committed to representing the company in an honest, ethical and professional manner.

Single Checkbox Field

Yes, I confirm that all of the information entered is true and correct.

Agent Application

Data Collection, Use and Consent

Company Information

Primary Contact Information

Historical Information

Agent Motivation

Reference Information

Reference #1 (Canadian School, College or University Representative)

Reference #2 (Other)

Declaration of Intent and Accuracy

Office Location

Communities

Applications

Other Links