EmailMeForm
CHANGE OF AGENT FORM
*To be completed by the student*
Student Information
Student Email:
*
Last Name:
*
Middle Name:
First Name:
*
Current Application Number:
*
Date of Birth: (Month, Day, Year)
*
MM
/
DD
/
YYYY
Current Agent Information
(If applicable – only complete if you are currently working with an agent)
Original Agency Name:
Original Agent Consultant Name:
Telephone Number:
Email Address:
Have you already paid a deposit or full tuition fees?
*
Yes
No
*Describe reason for changing agents (if applicable – only complete if you are currently working with an agent):
New Agent Information
(*Mandatory*)
Agency Name:
*
Agent Consultant Name:
*
Telephone Number:
*
Email Address:
*
Have you notified your original agent that you are no longer working with them? (if currently working with an agent)
*
Yes
No
By submitting this form, you give Canadore College permission to share details of this form to both your original and new agent if required.
