GETI Agent Application Form

GETI Education Agent Application Form

Application form to become a registered agent with GETI, representating Tasmanian Government Schools and TasTAFE.

"*" indicates required fields

Step 1 of 4 - Company Details

Company Contact Details

Please enter the contact details of your agency.

Name of organisation:*

Please enter the name of your organisation / agency.

Name of Managing Director:*

Please enter the name of the managing director of your company

Prefix First Last

Company registration number or Australian Business Number (if applicable):

Please enter the Australian Business Number if you have one.

Head Office Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Head Office Telephone:*

Generic Email :*

Please enter the email address you would like us to include in our mailouts.

Agency website:*

Name of main contact person for Agreement:*

Email of main contact person for Agreement:*

Agency Branches (if applicable) Branch 1

Please enter the details of any additional branches of your company (if applicable). This is to list your offices on the GETI website.

Branch Information 1

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone number of Branch 1

Generic Email of Branch 1 (This will be used in GETI's agent list page)

Name of principal agent in the branch: (this person will be listed in CoE)

Prefix First Last

Email of principal agent in the branch:

Agency Branches (if applicable) Branch 2

Please enter the details of any additional branches of your company (if applicable). This is to list your offices on the GETI website.

Branch Information 2

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Generic Email : (this will be used in GETI’s agent list page)

Name of principal agent in the branch: (this person will be listed in CoE)

Prefix First Last

Email of principal agent in the branch:

Additional Branches (if applicable)

If you have more branches you want us to list ion the GETI website, you can provide a list of branches with the information above.

If you have more branches you want us to list in the web, you can provide a list of branches with information above.

Drop files here or

Accepted file types: (iejpg, gif, png, pdf, docx, doc), Max. file size: 128 MB, Max. files: 50.

Referees

Please provide details of two referees from providers at Australian education institutions that you represent. We may contact these people to obtain further information.

Referee 1: Institution Name*