Company Agent Application

APPLICATION TO BECOME A WILLIAM ACADEMY’S AGENT-AGENCY

Please fill in the information below. ( required * )

William Academy respects your privacy.
The information that you have entered into this form will be kept confidential.

Student and Family Information:

    Company Name:* :*

    Address:*

    City :*

    Province :*

    Postcode:*

    Your Country:*

    Year Established:*

    Number of staff:

    Number of Offices:

    Person in Charge:*

    Title:

    Phone Number:*

    Fax:

    Email:*

    Web:*

    Contact Information In Canada:

    Contact in Canada:

    Title:

    Address:

    City:

    Province:

    Postcode:

    Phone Number:

    Fax:

    Email:

    What Canadian school boards or high schools do you currently represent?

    Number of students you sent to Canada during the past two years?

    Please list any memberships in industry-related associations or organizations:

    Is there any other information you would like to provide us about your company?