Step 1 of 2 50% Agency/Company InformationAgency Name*Address* Street Address Address Line 2 City AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*(Country code, City code, Number)What country will most of your students come from?*Email Address (from)* Enter Email Confirm Email Website* President or DirectorTitle*Name* First/Given Name Surname/Family Name Phone*(Country code, City code, Number)Email* Main Contact PersonSame as Above?* Yes No TitleName First/Given Name Surname/Family Name Phone(Country code, City code, Number)Email General InformationWhat year was your company established?How many students did you send to the USA during the past year?*What percentage of your students are interested in a Bachelor's Degree?*What percentage of your students are interested in a Master's Degree?*What percentage of your students are interested in a Doctorate Degree?*Does your company have a government license?* Yes No Are you are your agency a member of any professional association?* Yes No If yes, please list association name(s).Have you or your agency ever received an award or recognition from the government or another organization?* Yes No If yes, please list award name(s).Is your agency already working with other universities in Texas or other states?* Yes No If yes, please indicate which universities.Optional: Please describe any special features of your agency. What makes it special or different from others?How did you hear about Houston Christian University?*We have some basic expectations of all our Recruitment Partners. For example, our Partners should: • Answer all of the student’s admissions related questions • Provide pre-departure orientation • Provide information/assistance with applying for a student visa • Provide all of a student’s application materials directly to HCU Admissions Please indicate if the above services are already part of your typical service:* Yes No If yes, please explain: ReferencesPlease list references you may have from another institution.Reference #1Name First/Given Name Surname/Family Name TitleCompany or School NamePhone(Country Code, City Code, Number)Email Reference #2Name First/Given Name Surname/Family Name TitleCompany or School NamePhone(Country Code, City Code, Number)Email Confirmation*I certify that the information provided above is correct. I understand that Houston Christian University may terminate its relationship with me, my agency, or any associated representatives for any reason and at any time. Yes Digital Signature*Title, Name, Date
