International Representative Application Form

Request Information Form

Section 1 - Personal Details

Title: *

Family Name: *

Other Name(s): *

Home Address

House Number /Name: *

Street name: *

Town/City: *

County / District / State: *

Country Name: *

Postal Code/Zip Code: *

Telephone Number: *

Mobile: *

Education & Training Academic qualifications

Undergraduate: *

Title of Award: *

University: *

Postgraduate: *

Title of Award: *

University: *

Professional qualification: *

Title of Award: *

Awarding body: *

*To be completed by the most senior person with whom the College may be dealing, eg Company Director, Senior Manager. The individual must have authority to enter into contractual obligations on behalf of the company.

Section 2 - Company Details

Title of Company:

(Note: Commission payments can ONLY be made payable to this name; if requesting payments to be made to the name of an individual, please put this name as "Company")

Address of company (main office)

Number and street name: *

Town/City: *

County / District / State: *

Country Name: *

Postal Code/Zip Code: *

Telephone (main office): *

Fax (main office): *

Email: *

Website: *

Number of Subsidiary Offices: *

Location(s) of Subsidiary Offices: *

Date Company Established: *

Number and type of staff employed

Executive/Management: *

Full Time

Part Time

Clerical/Administrative: *

Full Time

Part Time

How many student counsellors does the company employ?: *

Nationality(ies)/citizenship of students that you wish to recruit: *

Section 3 - Company history

Is the company registered with the British Council? (if applicable): *

Yes

Please indicate which study programmes from the College portfolio would be of significant interest in the market in which you operate.

Please state any other UK universities or colleges you represent

1.:

2.:

3.:

4.:

Whether the college can approach your existing university or college clients for the purposes of providing business references: *

Yes

If Yes, please provide reference details

Reference details

Contact Name:

Institute Name:

Address 1:

Town/City:

County / District / State:

Country Name:

Postal Code/Zip Code:

Email:

Website:

Please indicate which study programmes from the College portfolio would be of significant interest in the market in which you operate.

1.:

2.:

3.:

4.:

Please provide samples to the College of any promotional material currently in use by the company with any other relevant information in support of your application

SECTION 4 - Certification

I certify that the information provided above, for the purpose of the college assessing the potential of the company to act on behalf of the college in the recruitment of students, is accurate

Name: *

Date: *

Note:

Please complete in full and return to the College by fax on 00 44 121 212 0666 or by email at intl@bcol.co.uk or by post at the address given above.
The College will undertake assessment of your application and notify you of the outcome by email or post.

What code is in the image?: *

Copy the characters (respecting upper/lower case) from the image.