EmailMe Form - USE OF AGENT FORM

Agent Information

(*Mandatory*)

Agency Name: *

Agent Consultant Name: *

Telephone Number: *

Email Address: *

Student Information

Last Name:

Middle Name:

First Name:

Current Application Number:

Date of Birth: (Month, Day, Year)

MM / DD / YYYY

Email Address:

Contact Telephone Number:

By signing this form,

I (the agent), recognize the following:

1. The above student has already submitted an application directly to Canadore College;
2. Have an active Agent Agreement in place with Canadore College;
3. Agreed to counsel and assist the student in re-submitting a new application on behalf of the student;
4. Am not eligible to claim commission for this student.