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ELI: Agent Application
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Agency Application Form
Agency Name
Company Contact Information
Please enter the main contact information for your company
Email - please list the main/general email address for the organization
Email Address
Phone
Mobile Phone
Primary Phone
Agency website
Primary Contact Person
Who will be the main point of contact between your company and the University of Delaware ELI?
First Name
Middle Name
Last Name
Title
Mailing Address
Mailing Address
Country
Street
City
Region
Postal Code
Additional email (if not the same as above)
Email Address
Information for Agreement
This is the information that will appear on your contract with the University of Delaware ELI. Please provide us with information about the person who will sign the contract for your company. This person should be a manager or financial officer who has the right to sign contracts on behalf of your company.
Is the financial officer the same as the contact listed above?
Is the financial officer the same as the contact listed above?
Yes
No
If no, please complete:
Financial Officer: First Name
Financial Officer: Last Name
Financial Officer: Email Address
Financial Officer: Telephone Number
Financial Officer: Title
Company Information
Please enter the information for your company
Company Business & Marketing Information
In this section, you will provide information about your company, its operations, and the services offered to students.
What is your main area of business?
What is your main area of business?
International education consulting (for profit; i.e., your company requires a commission payment)
Travel agency
Other (Please describe below)
Do you assist students from outside your country?
Do you assist students from outside your country?
Yes
No
If so, what country or countries (other than your own) do you assist students from?
How many people does your company employ?
How many staff members do you employ to work directly with students?
How long have you been working in international educational exchange?
To which countries do you send students (with approximate numbers sent)?
How many students to you send abroad each year?
To which type of programs do you send students?
To which type of programs do you send students?
High school
ESL Programs
University
Professional training
Tourists
Other
Which services do you provide to students?
Which services do you provide to students?
Program selection and advising
Admissions/application assistance
Passport/visa applications/preparation
Pre-departure orientation
Travel arrangements/airline tickets
Purchase medical insurance
Guide/chaperone while traveling
Other
Do you charge any fees? If so, please list them here.
To which professional organizations do you belong?
Are you certified by the American International Recruitment Council (AIRC)?
Are you certified by the American International Recruitment Council (AIRC)?
Yes
No
In Process
Why the University of Delaware ELI?
How did you hear about the University of Delaware English Language Institute (ELI)?
Why do you wish to represent the University of Delaware English Language Institute (ELI)?
Documents to Submit with Application
Please send the following documents to the ELI by email at ud-eli@udel.edu or upload below:
Brief profile (1-2 pages) about your company;
List of references (i.e., Institution Name, Contact Name, Title, Address, and Email) of at least three US institutions whom you currently represent; and
Proof of AIRC certification, if applicable.
Agency Profle
Reference
AIRC Certification
Signature
I certify that the information submitted on this application is true and correct. I understand that I am applying to become an agent of the University of Delaware English Language Institute for ESL programs, and that any agreement signed will not cover the university’s degree programs.
I certify that the information submitted on this application is true and correct. I understand that I am applying to become an agent of the University of Delaware English Language Institute for ESL programs, and that any agreement signed will not cover the university’s degree programs.
Yes
Entering your name here will serve as your Signature
Submit
