Agent Nomination Form

Instructions for Completing and Submitting the Edith Cowan University (ECU) Agent Nomination Form

Step 1: Complete Section A – Student Details (To be filled by the Applicant)

Fill in the following personal information accurately:

Student ID: Your ECU-issued student identification number.
Student Given Name(s): Your first name(s) exactly as per your passport.
Student Family Name: Your surname exactly as per your passport.
Date of Birth: In the format DD/MM/YYYY.
Student Address: Your current residential address.
Previous Agency Name: Name of the previous education agency (if any).
Reason for Change of Agent: Clearly state why you are changing your agent.

Step 2: Complete Section B – New Agent Details (To be filled by the New Agent)

Your new education agent must fill in this section:

Agency Name: Official name of the new agency.
Branch Office: Specify the branch if the application is not managed by the main office.
Agent Portal ID Number: If known, provide the agent’s ECU Portal ID.

Step 3: Complete Section C – Student Declaration (To be signed by the Applicant)

Read each point carefully and acknowledge that you:

Authorise the nominated agent to communicate on your behalf regarding your ECU application.
Understand ECU may verify the information you provide.
Are aware that providing false or misleading information is an offence.
Confirm you have:
a. Made your own enquiries about the course suitability.
b. Taken sole responsibility for compliance with ECU’s admission rules.
Agree your information may be shared with government agencies if required.
Will comply with ECU’s Statutes, By-laws, Rules, and Regulations.
Have reviewed ECU’s official governance documents at ECU Legislation.
Understand that ECU communicates officially via electronic means unless otherwise arranged.
Agree to notify ECU about any changes to your address or contact details.

Student Signature & Date: Sign and date the declaration where indicated.

Important Notes:

If you have already accepted an offer or are enrolled at ECU, the new agent is not eligible for commission unless you are transferring to a new course after completing your current one (e.g., Bachelor to Master).
ECU does not notify your previous agent about this change; you must handle that independently.

Step 4: Submit the Completed Form

Email the fully completed and signed form to:
admissions@ecu.edu.au

For further assistance, you can contact ECU Admissions at +61 8 6304 5377 or via the email above.

Download Edith Cowan University (ECU) Agent Nomination Form

Personal Details

Title

Given Names

Middle Name (if Applicable)

Family Name

Country of Passport

Telephone

Email

SECTION A: Student details

STUDENT ID

STUDENT GIVEN NAME(S)

STUDENT FAMILY NAME

DATE OF BIRTH (DD/MM/YYYY)

Full Address

Suburb

City

State

Postcode

PREVIOUS AGENCY NAME

REASON FOR CHANGE OF AGENT

SECTION B: New agent details (To be completed by AGENT)

AGENCY NAME

BRANCH OFFICE (if application is not managed by the main office)

AGENT PORTAL ID NUMBER (if known)

SECTION C: Student declaration

I authorise the above to communication on my behalf in regards to my application to ECU.
I acknowledge that Edith Cowan University reserves the right to make such enquiries as may be reasonably necessary to verify the information provided by me in this application including, with regard to my educational qualifications.
I understand that providing false and misleading information to obtain admission and/or credit into a course is an offence.
I confirm
1. I have made my own enquiries as to the suitability of the course that I am seeking to be enrolled; and
2. that it is my sole responsibility to ensure that my enrolment is in accordance with the Admissions Enrolment and Academic Progress Rules of Edith Cowan University.
I acknowledge and agree that the information provided by me to Edith Cowan University may be provided to Commonwealth and State agencies when required by law.
If I am admitted into a course with Edith Cowan University I agree to comply with the Statutes, By-laws, Rules ...

I acknowledge I have had the opportunity to peruse the Statutes, By-laws, Rules and Regulations of Edith Cowan University at: www.ecu.edu.au/GPPS/governance_services/legislation.
I acknowledge that official communication by Edith Cowan University to me will be by electronic means unless alternative communication arrangements have been agreed by ECU.
I agree to notify ECU of any changes to my residential addresses whether in Australia or another country and to any change in the contact information in the event of an emergency.

If you have concerns about any of the above items please contact ECU Admissions on (61 8) 6304 5377 or email to admissions@ecu.edu.au.

Disclaimer

If the student has already accepted their offer or is enrolled at ECU, the new agent is not eligible for commission with the exception of a current ECU student intending to move to a new course of study after the completion of their current course (example Bachelor to Master).
It is not ECU’s responsibility to inform the previous agent of this change

Date

PLEASE FORWARD THE COMPLETED FORM TO ADMISSIONS@ECU.EDU.AU

अधिक जानकारी के लिए अनुरोध

Edith Cowan University

CRICOS CODE 00279B

संस्था का शीर्षक:

Edith Cowan University

के रूप में भी व्यापार कर रहे हैं:

Edith Cowan University

इंस्टीट्यूशन क्रिकोस कोड:

00279B

संस्था का प्रकार:

Government

जगह:

Western Australia 6027

वेबसाइट:

https://www.ecu.edu.au

छात्रों की कुल संख्या:

8380

- कृपया अंग्रेजी में जानकारी दर्ज करें

यदि आपकी उम्र 18 वर्ष से कम है, तो यह आवश्यक है कि यह फॉर्म आपके माता-पिता द्वारा भरा जाए।

Step 1: Complete Section A – Student Details (To be filled by the Applicant)

Step 2: Complete Section B – New Agent Details (To be filled by the New Agent)

Step 3: Complete Section C – Student Declaration (To be signed by the Applicant)

Important Notes:

Step 4: Submit the Completed Form

SECTION A: Student details

SECTION B: New agent details (To be completed by AGENT)

SECTION C: Student declaration

इस पृष्ठ को अपने नेटवर्क के साथ साझा करें

अधिक जानकारी के लिए अनुरोध

Edith Cowan University

CRICOS CODE 00279B

Agent Nomination Form

संस्था का शीर्षक: Edith Cowan University

के रूप में भी व्यापार कर रहे हैं: Edith Cowan University

इंस्टीट्यूशन क्रिकोस कोड: 00279B

संस्था का प्रकार: Government

जगह: Western Australia 6027

वेबसाइट: https://www.ecu.edu.au

छात्रों की कुल संख्या: 8380

- कृपया अंग्रेजी में जानकारी दर्ज करें

यदि आपकी उम्र 18 वर्ष से कम है, तो यह आवश्यक है कि यह फॉर्म आपके माता-पिता द्वारा भरा जाए।

Step 1: Complete Section A – Student Details (To be filled by the Applicant)

Step 2: Complete Section B – New Agent Details (To be filled by the New Agent)

Step 3: Complete Section C – Student Declaration (To be signed by the Applicant)

Important Notes:

Step 4: Submit the Completed Form

SECTION A: Student details

SECTION B: New agent details (To be completed by AGENT)

SECTION C: Student declaration

इस पृष्ठ को अपने नेटवर्क के साथ साझा करें

संस्था का शीर्षक:

Edith Cowan University

के रूप में भी व्यापार कर रहे हैं:

Edith Cowan University

इंस्टीट्यूशन क्रिकोस कोड:

00279B

संस्था का प्रकार:

Government

जगह:

Western Australia 6027

वेबसाइट:

https://www.ecu.edu.au

छात्रों की कुल संख्या:

8380