CHANGE OF AGENT NOMINATION FORM
Information for international students
By completing this form, you are formally advising La Trobe University of your intent to nominate a new agent to
represent you in your application to study at La Trobe University. The admissions outcome from any agency will be the
same so the decision to nominate a different agent will depend on your satisfaction with their service.
Lodging the form
This form is strictly to be used by new applicants only. If you have accepted an offer to study at La Trobe, your application
won’t be considered.
• The agent nomination form needs to be duly filled and signed by the student and the new agent.
• ALL fields must be completed, including the name of the previous agent and the reason for the change.
• The form must be submitted to the International Admissions Office via email at [email protected].
Please contact the International Admissions Office if you have a question on how/when to fill this form.
Section 1 – To be completed by the student
Personal Details
Family Name Given Names
Email ID La Trobe Student Number (if known)
Date of birth Telephone number
Current Address
Course Intake (Semester, year)
Name of current agent (if any)
Reason for change
I did not have an agent before, I am nominating an agent for the first time.
I moved to a different city/country and have found another agent to continue my application process.
I am not satisifed with the services provided by my previous agent.
The new agent provides the service/support that the other agent did not.
Other (explain):
• I request that the above nominated agent act and on my behalf in relation to my application to study at La Trobe
University.
• I give my consent to the University to disclose my personal information to the above agent for the purposes of my
application.
• I acknowledge I have read and understood the information stated on this form and certify that the information provided is
complete and correct.
Signature of student Date signed
Privacy Policy: Refer to the University Policy website at latrobe.edu.au/privacy or telephone 1300 LA TROBE (1300 52 87623)
International Admissions – February 2021 - Version 1.2
CRICOS Provider Number: 00115M
Section 2 – To be completed by the agent
Agent declaration
1. I am satisfied to the best of my knowledge that the applicant is a genuine student who intends to complete the
course/s applied for at the University and meets genuine temporary entrant requirements.
2. I have sighted and verified identification documentation and can confirm the identity of the applicant is true
and correct.
3. I commit to verify all documents supplied by the applicant in support of this application once I have access to
their application in the La Trobe Admissions portal. If I determine any fraudulent content, I will report to La
Trobe University.
4. I have provided the applicant all relevant information to enable them to make an informed decision about
studying at the University and their chosen course.
5. I have informed the applicant of the conditions attached to a student visa and their obligation to have sufficient
funds to pay for all associated study costs and all living and travel expenses for themselves and any
dependent/s travelling to Australia for the entire duration of their stay.
6. By signing this form, I am confirming that I understand and have discussed with the student and agreed on the
declarations above.
Nominated agency
Counsellor's name
Counsellor's email
Counsellor's signature
Date signed
Privacy Policy: Refer to the University Policy website atlatrobe.edu.au/privacy or telephone 1300 LA TROBE (1300 52 87623)
International Admissions – February 2021 - Version 1.2
CRICOS Provider Number: 00115M
