AGENT REQUEST TO REPRESENT CCUSA

Thank you for your interest in becoming an agent for CCUSA. Please note that ALL fields in the following request form are required. If there is something that is not relevant, please place "Not Applicable" in the box or select it from the drop down box.

Upon receipt of the completed form, a CCUSA representative will contact you within 2 working days.

 
Please provide the following information regarding your company
   
Company name:
Parent Company (if any):
Owner of Company:
Date Business was Founded:
Number of years in business:
What type of Company:
Business license #:
Business license issued by:
Mailing address:
Contact Person:
Contact Person's Title (i.e. Director)
Contact Phone: (Inc international dialing details)
Contact Fax:
Contact E-mail:
Company Website:
Number of Full Time Employees:
Number of Offices in main country of operation:
International affiliations or memberships your company holds in the following (FIYTO, ISTC, DWEA, IATA, ALTO, IAPA, other):
   
Participant Recruitment
   
What countries are you recruiting from?
Does your country require registration with the government to operate a citizen or student exchange program?
If yes, what is the date of your registration?
How many universities are you recruiting from?
Do you have affiliations with universities?
If yes, please list the universities:
Please describe in detail how you assess the English proficiency of your applicants for Work Experience and/or Camp Counselor programs:
   
Program Information (inbound to the U.S.)
   
Interested in the Work Experience USA (WEUSA) Program?
Have you previously sent participants to the United States?
If so, how many Work and Travel participants per year?
How many visas were denied?
Who was your U.S. sponsor?
What are your estimated numbers for the WEUSA Program?
How many placements would you require from CCUSA to reach your estimated participant number?
What job positions are your participants interested in?
What area(s) of the United States are your participants interested in?
   
Based on the official university Break Dates in your country, please list the:
Dates your participants are available to start work in the United States:
Dates your participants have to end work in the United States and return home:
Will you continue to work with other J1 sponsors for Work and Travel if you become a CCUSA partner?
How many staff could you allocate to run this program in your office?
   
Program Information (inbound to the U.S.)
   
Interested in the Camp Counselors USA (CCUSA) Program?
Have you previously sent participants to the United States?
If so, how many per year do you send for:
Camp Counselors Support Staff
How many visas were denied?
Who was your U.S. sponsor?
Dates your participants are available to start work in the United States:
Dates your participants have to end work in the United States and return home:
Will you continue to work with other J1 sponsors for Camp Counselors if you become a CCUSA partner?
How many staff could you allocate to run this program in your office?
   
   

Interested in the 12 and 18 month Practical Training USA (PTUSA) Program?

Have you previously sent participants to the United States?

If so, how many per year do you send for:
How many visas were denied?

What are your estimated numbers for the PTUSA Program (12 and 18 month)?

 
  12mth program 18mth program

How many of these would be CCUSA placements and how many would be where the participant has found their own position?

 
CCUSA Placement Own Placement

CCUSA’s designation is in Business,

Management, Finance & Commerce,
Media & Communications
Hospitality & Tourism
What job positions are your participants interested in?
How many staff could you allocate to run this program in your office?
   
Other program information:
   
Do you place participants in other countries besides the U.S.?
If so, where
What other Work, Volunteer or Camp programs do you have experience with (sending participants or receiving groups)?
   
Business References:
#1
Business Name:
Contact Name:
Contact Title:
E-Mail Address:
Phone Number:
Number of years working with business:
   
#2
Business Name:
Contact Name:
Contact Title:
E-Mail Address:
Phone Number:
Number of years working with business:
   
#3
Business Name:
Contact Name:
Contact Title:
E-Mail Address:
Phone Number:
Number of years working with business:
   
US Consulate Requirements:  
If you are going to be selling CCUSA programs to the USA, please provide additional documentation of your involvement with the J-1 visa processes with the US Consulate in your country.
 
Please include, name and contact details from your contact at US Consulate, correspondence you have had with the Consulate on processing the J1 visa for this past year including requirements, and what regulations they follow in terms of age, student status etc.
 
If this will be the 1st time you will have any dealings with the US consulate you will need to make an appointment with them to discuss the J-1 visa and how they process the J1 visa, their requirements for participants in terms of age, student status, and any other additional proof that is required before we can move ahead with confirming your agent request.
 
OTHER:
   
How did you hear about CCUSA?
Additional Feedback?