City* State or Province*
Country* Postal Code*
Phone * (Country code, City code, Number) Fax
What country will most of your students come from? Email address ( from )* Email address ( type again for confirmation)* Website
President or Director
What year was your company established? How many students did you send to the USA during the past year? *
What percent of your students are interested in the following programs?
Do you or your company have a government license? yes no Please fax (206-546-7854) or email a copy to Samira Pardanani. Are you or your agency a member of any professional association?
yes no Association Name Have you or your agency ever received an award or recognition from the government
or another organization? yes no Award Name Is your agency already working with other community colleges in Washington or other
states? yes no If so, please indicate which ones: Optional: please describe any special features of your agency. What makes it special
or different from others? You may also fax or email a company profile to Diana Sampson (206-546-7854). How did you hear about Shoreline Community College? We have some basic expectations of all our Recruitment Partners. For example, our
Partners should: -answer all of the student's admissions related questions -provide pre-departure orientation -provide information/assistance with applying for a student visa -provide all of a student's application materials directly to our Office Please indicate if these services are already part of your typical service. * yes no Have you, your agency, or any employee of the agency ever been involved in a past
or pending legal dispute related to educational advising? * yes no
If yes, please explain:
Please list references you may have from another institution. Though we prefer to have references, we will
still consider your application if none are available.
I certify that the information provided above is correct. I understand that Shoreline
Community College may terminate its relationship with me, my agency or any associated
representatives if the College has reason to believe that any of this information
is false. Yes* Title*