Agent Application

Thank you for your interest in LSDM. Please complete the form below to apply as an International Representative.

About You
Name
First Last
Email
Phone
Your Organisation
Organisation Name
Company Number
Main Office Location
Main Office Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
No. of Employees
Primary Language(s)
Website
About Your Organisation
How long has your organisation been trading?
How many regional offices do you have?
A "regional office" may include independent affiliated agents, regional / local franchises or branch offices.
In the last 2 years, how many students have you recruited?
This is the total number of students recruited by your organisation into higher education institutions and universities.
Please list the Institutions / Universities you work with.
Provide a URL to your website listing your client testimonials or write each university on a separate line (up to 10).
Annual Turnover
Have you (or your agents) received training from the British Council?
Are you in compliance with Quality Assurance Agency for Higher Education ("QAA")?
Do you or your company directors have any criminal convictions (past or present)?
Customer Reference - Higher Education Institution
Institution Name
Job Title
Name
First Last
Email
Phone
File
Max. file size: 256 MB.
Customer Reference - Student
Name
First Last
Email
Phone
File
Max. file size: 256 MB.
Financial Details
Account Holder
Account Holder Name
First Last
Bank Name
Bank Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
IBAN
BIC/SWIFT
Consent
Accept Declaration
I declare that the details I have provided are accurate to the best of my knowledge and warrant that I have the authority to bind myself or the aforementioned organisation to these Terms & Conditions.
CAPTCHA

About You

Your Organisation

About Your Organisation

Customer Reference - Higher Education Institution

Customer Reference - Student

Financial Details