International Medical & Educational Group
BUSINESS ASSOCIATE APPLICATION FORM

Please note, this is a questionnaire that we wish to get your feedback on. This will help us to understand your organization better and your market better. Please fill this as per actual conditions.

Once we are satisfied with your application, we shall support your marketing efforts and also conduct seminars for you in your country. This may take Ten minutes of your time

Just type "NA" where ever Not Applicable

* Fields Are Mandatory

About Your organization and its people
Name of the Organization * Year of Incorporation *
Address for Correspondence
Address * City *

State/Province *

Country *





Name of Managing Director/CEO *
Telephone
Direct Line *
Country Code *     Area Code *       Phone Number *
       

Mobile/Hand phone *
Country Code *     Phone Number *
   

Email 1 * Email 2
Website *
Name of contact for further Correspondence
Position of the Contact * Contact Person name *
Direct Line *
Country Code *     Area Code *       Phone Number *
       

Mobile/Hand phone *
Country Code *     Phone Number *
   

Email *
Number of Staffs
Administrative Counselors
Marketing Support
About your services and facilities
Does local Law officially license you to operate as agent * Yes No
Is your company or Part thereof known under any other name * Yes No
Do your premises comprise a consultation area where students can look at information * Yes No
Are there facilities for Video Play back * Yes No
Are there computing facilities with Internet access for students to use? * Yes No
Do you train students for IELTS * Yes No
Do you train students for TOEFL * Yes No
Do you train students for GRE * Yes No
Do you train students for GMAT * Yes No
Do you train students for Others, Please Specify
Do you participate/ Under take Advertisements in your local news papers * Yes No
Do you participate/ Under take Education Fairs * Yes No
Do you participate/ Under take Seminars and Road Shows * Yes No
Do you currently Represent any institutions in the following countries
USA University 1         No of students sent last batch    

University 2         No of students sent last batch    
UK University 1         No of students sent last batch    

University 2         No of students sent last batch    
Australia University 1         No of students sent last batch    

University 2         No of students sent last batch    
Czech University 1         No of students sent last batch    

University 2         No of students sent last batch    
Slovak University 1         No of students sent last batch    

University 2         No of students sent last batch    
Croatia University 1         No of students sent last batch    

University 2         No of students sent last batch    
Canada University 1         No of students sent last batch    

University 2         No of students sent last batch    
Singapore University 1         No of students sent last batch    

University 2         No of students sent last batch    
NewZealand University 1         No of students sent last batch    

University 2         No of students sent last batch    
Malayasia University 1         No of students sent last batch    

University 2         No of students sent last batch    
China University 1         No of students sent last batch    

University 2         No of students sent last batch    
Philippines University 1         No of students sent last batch    

University 2         No of students sent last batch    
Russia University 1         No of students sent last batch    

University 2         No of students sent last batch    
Ukraine University 1         No of students sent last batch    

University 2         No of students sent last batch    
Belarus University 1         No of students sent last batch    

University 2         No of students sent last batch    
Hungary University 1         No of students sent last batch    

University 2         No of students sent last batch    
Poland University 1         No of students sent last batch    

University 2         No of students sent last batch    
Any other Country, Please Specify
Which of our programs you ll be interested to recruit students for - Press ctrl For Multi Select
Which are the Provinces in your Country that you would like to market our programs in
Promotions *
Have you given Paper advertisements by your self for Last Year (2016) admissions Yes No
Have you participated in education fairs on your own expenses Yes No
Have you done seminars and road shows on your own expenses Yes No
Which Month are the Results for the High School each year students expected
Which month do we need to start promotions for March Intake
Which month do we need to start promotions for September Intake
Which are the leading news papers to cover your country completely *
# Leading Paper Name Region Covered
1
2
3
4
5
Which are the leading education fairs in your country
One
Name Organized by
Time of year Locations
Two
Name Organized by
Time of year Locations
Three
Name Organized by
Time of year Locations
Which are the leading Youth Magazines that are popular in your country and read by most number of students
Magazine 1 Magazine 2
Any web portals where advertising would bring good responses
Web Portal 1 Web Portal 2
Web Portal 3 Web Portal 4
Best cities to do seminars and get good response
City 1 City 2
City 3 City 4
If there is a budget of 10,000 US$ for promotions in your region what is the best ratio to distribute the total budget *
1 News Paper
2 Magazine
3 Seminar
What are the modes of advert that will reach the students in your country ?
1 Radio [ If Yes, Mention the Radio names ]
2 News paper [ If Yes, Mention the News paper names ]
3 TV [ If Yes, Mention the Channel names ]
4 Magazines [ If Yes, Mention the Magazine names ]
5 Others [ If Yes, Specify ]
What should our strategy be to get maximum number of students *
We would like to get a reference of your organization from two Universities/College that have send student to already in the previous year *
Reference One
College/University Name Contact Person Name
Position of Contact Person Email ID of Contact Person
Direct Line
Country Code        Area Code          Phone Number
       

Reference Two
College/University Name Contact Person Name
Position of Contact Person Email ID of Contact Person
Direct Line
Country Code        Area Code          Phone Number
       

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