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Thank you for your interest in representing San José State University.
We welcome the opportunity to serve students referred by your agency, and we'd like to learn more about you
and your agency. Please complete the following questionnaire. When you have finished, click on the "SUBMIT"
button.
If you'd like more information about our university, please visit us at: sjsu.edu/global.
Fields marked (*) are mandatory.
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| Organization Type |
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| Organization Status |
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| Salutation |
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| Contact's Last Name* | |
| Contact's First Name* | |
| Contact's Email* | |
| What program(s) is/are your agency interested in?* |
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| Company/Agency Name* | |
| Year Established/Founded |
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| Company's Email | |
| Street Address* | |
| Street Address 2 | |
| State* | |
| Country* |
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| Zip Code | |
| More Address Information | |
| Phone* | |
| Fax | |
| Website | |
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| Is your Agency certified by AIRC?* |
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| If not, Is your agency licensed by the government of your country? |
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| Please provide Licence Details | |
| Do your agents have training in advising students?* |
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| Please provide training details | |
| Does your agency provide pre-departure orientation to students going to the United States?* |
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| Please provide Orientation details | |
| What other services does your agency provide to U.S. bound students?* |
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| How does your agency advertise its services?* |
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| Specify Region | |
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How many students has your agency placed in the U.S. during the past 12 months?
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| Undergraduate* | |
| Graduate* | |
| Conditional Admission* | |
| Intensive English Program* | |
| Short-Term Visiting Students* | |
| Do you have an active agreement with SJSU?* |
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| Do you contract with other agents to provide you with students?* |
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| What else would you like to tell us about your agency? | |
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| Please list the names and contact information of three U.S. based colleges or universities who can serve as reference for your agency. |
| First College or University (reference)* | |
| First Reference Contact Name* | |
| First Reference Contact Email* | |
| Second College or University (reference)* | |
| Second Reference Contact Name* | |
| Second Reference Contact Email* | |
| Third College or University (reference)* | |
| Third Reference Contact Name* | |
| Third Reference Contact Email* | |
| How did you learn about SJSU? |
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| Have you ever visited SJSU? |
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