Test Agency Content

Agency Name

Agency Mailing Address - Street

Agency Mailing Address - City

Agency Mailing Address - State/Province

Agency Mailing Address - Postal Code

Agency Mailing Address - Country

Agency Email Address

Agency Phone Number

Agency Homepage URL

Year of Agency Establishment

Agency Owner Name(s)

Primary Contact First Name

Primary Contact Last Name

Primary Contact Title

Primary Contact Email

Primary Contact Phone

Have you or your staff ever been through any formal training related to working as an educational agent? *

Cities where you recruit actively

Describe your marketing and recruitment strategy

Please list the services your company provides and any related fees

Annual number of students you expect to send to Lane Community College

Please provide the names and email addresses for two references at schools, preferably in the United States.

Reference School

Reference Contact

Reference Email

Reference School 2

Reference Contact 2

Reference Email 2

Are you a member of AIRC? *

Please provide a brief company profile outlining your previous work and education background

Is there anything else that you would like us to know?

Do you declare that the information in this application is true and correct?

We require a copy of your agency's business license to complete the application process. Please confirm here that you will send a copy of your business license to internationaladmissions@lanecc.edu. *

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