University of California Extension, Santa Cruz

Agent Profile

Please provide the following information so that we may better serve your needs.

Name and Title of Agent: Company Name: Address: City: State: Zip Code: Phone: Fax: E-Mail:

Please tell us about your company:

1. Your company is a:

__ Corporation __Self-Proprietorship __ Government Agency __ Non-Profit Organization

2. When was your company established? 19 ___ 20__

3. How many employees work in your organization?

__ 1-5 __ 6-10 __ 10+

4. Is your company licensed by your government? Yes __ No__ N/A__

5. How do you promote your services?

__ Newspaper/Magazine ads __ Presentations __ Information Libraries __ Brochures __ Schools __ Fairs __ Posters __ Direct Mail Intensive English Programs – Agent Profile

__ Internet Web Page __ Other: ______

6. Do you work with government agencies or schools in your country? If yes, please list: a. b. c.

7. Please list names of universities, schools, or private language providers with whom you work in the US, and names and contact information for at least two contact people at those institutions in total:

a. b. c. d.

8. Do you promote study abroad programs in other countries?

Yes __ If yes, where: ______No__

Please tell us more about your clients or target audience:

9. What types of clients are you targeting?

__ Universities __ Travelers __ Professionals __ Companies

10. What countries or regions are you recruiting students from? Please list.

a. b. c. d.

11. What types of programs are you targeting?

__ Professional Certificate Programs __ International Business __ International Marketing __ Trade and Commerce __ Network Management and Engineering __ Systems Administration and Management __ Translation & Interpretation __ Language Education __ Policy Studies

of 4 Intensive English Programs – Agent Profile

__ Environment Management __ Other areas of interest ______Intensive Language Programs __ Intensive English __ Business English __ Other Areas of Interest ______Custom Language Program __ One-on-one instruction

12. Length of study students are most interested in:

__ 3-4 Weeks __ 8-12 Weeks __ 6 Months __ One Year __ More Than One Year

13. What months of the year do MOST students want to study in the US?

__ January __ February __ March __ April __May __ June __ July __ August __ September __ October __ November __ December

14. How many students do you advise a year?

Please tell us more about your services:

15. What services do you provide your students?

__ Visa Assistance __ Air Tickets __ Pre-Departure Orientation __ Other: ______

16. Please check which fees you collect from students:

__ All __ None __ Commission Only (students pay balance to school) __ Some, please check: __Application fee __ Tuition __ Housing application fee __ Housing fees __ Student services fee __ Insurance _ Do you provide insurance? _ Yes _ No

17. Do you charge students for counseling?

of 4 Intensive English Programs – Agent Profile

__ Yes, how much: $ ______No

Please tell us how we can be of assistance to you:

18. How many brochures would you like to receive?

__ 1 __ 5 __ 10 __ 25 __ Other: ______

19. How often would you like to receive brochures?

__ Every Quarter __ Twice per Year __ Once a Year

20. Please check other material you would like to receive:

__ Posters __ Flyers __ Application Forms __ Other: ______

Please e-mail the completed form to Carol Johnson at [email protected] or fax the completed form to Carol Johnson’s attention at (831) 647-4188. We look forward to working with you.