Student Agent Application

STUDENT AGENT APPLICATION

Student Information

Student Full Legal Name:

Applicant is a minor (under 18):

Parent or Guardian Information (If Applicant is a Minor)

Agent Information

Appointment Details & Scope of Authority

Appointment commences on: and expires on: unless earlier revoked in writing.

This appointment authorizes the Agent to perform the following acts on behalf of the Applicant (mark all that apply):

Application submission and completion of admission documents
Communications with institution officials (admissions, registrar, housing, finance)
Obtain and receive academic and enrollment records
Negotiate tuition payment plans, billing, and financial arrangements
Visa, immigration, and compliance assistance related to study
Arrange housing or related placement services
Other (describe):

Fees, Payments, and Disclosure

The Agent's fees, commissions, and billing terms must be disclosed below. The Applicant acknowledges responsibility to pay the Agent in accordance with the terms set forth unless a separate written agreement governs fees.

Consents, Records & Privacy

By signing below the Applicant or Parent/Guardian authorizes the following (select all applicable):

Applicant consents to the release of academic, financial, disciplinary, and enrollment records to the Agent for purposes of application, enrollment, and related services.
Applicant consents to disclosure of necessary information to third-party service providers engaged by the Agent to perform services described herein.
Applicant consents to receive electronic communications and electronic signatures related to Agent activities and institutional communications.
Applicant acknowledges that data may be retained by the Agent and consents to retention consistent with the Agent's written privacy practices.

Representations, Warranties, and Indemnity

The Applicant represents and warrants that all information supplied to the Agent and to the educational institution is true and complete. The Agent will act only within the scope expressly authorized in this application. The Applicant agrees to indemnify and hold harmless the Agent and its representatives for claims arising from Applicant-provided misrepresentations, omissions, or failure to comply with obligations, except for willful misconduct by the Agent.

Termination and Revocation

This appointment is revocable by written notice from the Applicant or Parent/Guardian. Revocation does not affect the Agent's right to be paid for services performed or obligations incurred prior to receipt of revocation. The Agent may terminate this appointment for material breach or nonpayment upon reasonable notice.

Governing Law and Dispute Resolution

This application and any dispute arising from it shall be governed by the laws of the jurisdiction specified below. Parties agree to attempt in good faith to resolve disputes by negotiation before resorting to formal legal proceedings.

Acknowledgment and Certification

By signing below, the Applicant (or Parent/Guardian if the Applicant is a minor) certifies that: (1) the information provided in this application is true, complete, and accurate to the best of their knowledge; (2) they authorize the Agent to act as described in this application; (3) they have read, understand, and accept the terms and conditions set forth in this document; and (4) they consent to the disclosure and use of their information as indicated above.

Applicant certifies the truthfulness of statements and consents to the terms above:

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