IDP Nomination Form

THIS FORM VERIFIES THAT THE STUDENT BELOW HAS NOMINATED IDP EDUCATION
AS HIS/HER AUTHORISED AGENT FOR STUDENT RECRUITMENT PURPOSES.

This form is to be used for cases

A. Changes existing agent to IDP or
where a student:
B. Requests IDP services post applying direct to the
institution
Section A: Student Details
Student Family Name:
Student Given Name:
Student Date of Birth:
Institution Student

No/Ref:
Course Name:

Section B: IDP Office Details

Name (city):
Mailing Address:
Email Address:
Phone Number:
Fax Number:
Counselor Name:

Section C: IDP Services

Information & Advice to prospective students
IDP Service/s Provided i.e. counseling

(Please tick) Application Processing Assistance

Pre-departure Assistance
e.g.: visa assistance, health insurance

Service level Full Partial

Section D: Student Declaration

I ______________ , wish to confirm that IDP Education Pty Ltd in _______,
is my agent for student recruitment purposes.

Signature
Date

Section E: Institution Declaration

Please fax or email the completed form to IDP Education -office details are above
I hereby recognize IDP Education Pty Ltd as the agent for this student and confirm that it is eligible for
commission at the service level indicated above
Institution Representative Name:
Position Title :
Signature of Institution's Representative:
Date:
Not Approved Comments:

Version 1 March 2012