Award Agent Application Form

Organisation Details

Name of Organisation*

ABN*

Postal Address*

Postcode*

Street address same as Postal address*

Street Address

Postcode

Organisation Contact Number*

Organisation Website

For schools please indicate type*

The Authorising Officer is the most senior person within your organisation

Name*

Position within Organisation

Email*

Work Phone*

Date*

Agreement*

I acknowledge that if my organisation's application is accepted, an Award Agent Agreement document will be sent for completion and signing before any charges are incurred and before my organisation can commence operating as an Award Agent.

Leaders Details

Name	Date	Position within Organisation	Work Phone	Mobile Phone	Email	Actions
						Edit Delete
There are no Leaders.

Maximum number of leaders reached.

This section must be completed in full

Purpose for introducing the Award within your organisation*

Target Cohorts*

Description (i.e. year group/ class)

Number Per Annum

Total Participants Year 1 (projected)

Total Participants Year 2 (projected)

Total Participants Year 3 (projected)

Accounts department contact person*

Contact Email*

Registration Fee*

Price:

Exemption

Please tick this box if you are sponsored and are exempt from paying the fee.

Total

$ 0.00