Application for representation of

BROWNS English Language School

Business Name: ____________________________________________________________

Office Location: _______________________________________________________________

____________________________________________________________________________
Telephone: ___________________________

Fax: ______________________________

Email:

Website ___________________________

____________________________

Business History
How long have you been in operation as an education agent? ________
(Please provide a business plan if your company is new).
Does your company deal in areas other than international education?
______________________________________________________________________
______________________________________________________________________
What is the total number of students that your office recruits each year?
______________________________________________
Where (which countries) do you send most of your students?
_______________________________________________________
Do you work with any other education agents as a partnership or an affiliation?
________________________________________
Do you represent any other Australian institutions?(If Yes, please describe the institutions names.)
_______________________________________________________________________________

Agency information
Key staff contact (1) _____________________ Position _____________________
Key staff contact (2) _____________________ Position ______________________
Have you or any of your counselors ever visited Australia? ____________________

Postal Address:
PO Box 10485
Southport BC 4215
Queensland Australia

Brisbane Tel: +61 7 3221 7871

Gold Coast Tel: + 61 7 5561 1192
Brisbane & Gold Coast Fax: + 61 7 55611196

Email: info@brownsels.com.au
Web: www.brownsels.com.au
CRICOS Provider Number: 02663M
ABN: 23 067 191 491

Referees
Please include the details of two referees we can contact, including one educational institution.
Name:

Name:

__________________________________

__________________________________

Title:

Title:

__________________________________

__________________________________

Company name:

Company name:

__________________________________

__________________________________

Address:

Address:

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Phone:
____________________________________

Phone:
_____________________________________

Fax:
____________________________________

Fax:
____________________________________

E-mail:
_____________________________________

E-mail:
_____________________________________

Signed: ________________________________________________
Print Name: ____________________________________________
Position: _______________________________________________
Date: __________________________________________________

Thank you for taking the time to complete this form.

Please return to: Marketing Team
BROWNS English Language School
CRICOS Provider No 02663M
Fax: +61-7-5561-1192
E-mail: info@brownsels.com.au

Postal Address:
PO Box 10485
Southport BC 4215
Queensland Australia

Brisbane Tel: +61 7 3221 7871

Gold Coast Tel: + 61 7 5561 1192
Brisbane & Gold Coast Fax: + 61 7 55611196

Email: info@brownsels.com.au
Web: www.brownsels.com.au
CRICOS Provider Number: 02663M
ABN: 23 067 191 491