CIEE Partner Onboarding Form

Step 1 of 6

Agency Information

Provide your agency's basic business details and contact information.

Agency Business Name *

Country of Business *

City *

Street Address *

Agency Point of Contact *

Contact Business Phone *

Contact Email Address *

Agency Website URL

CIEE Agency Since

Partner Website URL

Step 2 of 6

Program Fee Structure

Detail all fees, costs, and pricing for your program participants.

Program Fee Overview

Currency

Program Fee — Amount

$

SEVIS Fee

$

Program Fee — Inclusions

Application fee Agent support pre-departure U.S. Sponsor support Orientation Insurance Plan Screening for program English eligibility test Administrative costs Translation of documents

Visa & Placement Fees

Visa Interview Fee

$

Promotion/Discount Amount

$

Pre-Placement Fee (By Sponsor)

$

Self Placement Fee

$

Non Pre-Placement Fee (Visa Waiver)

$

Administrative Costs

$

What do the Administrative Costs include?

Additional Service Fees

Interview/Screening Fee

$

English Eligibility Test Fee

$

Translation of School Documents Fee

$

Health Insurance Fee

$

Average Flight Costs

$

Expedited Forms/Documentation Fee

$

Non-Refundable Fees

Housing, Transportation & Totals

Housing Fee

$

Transportation Fee

$

Total Fees Excluding Airfare

$

Flight Estimated Cost

$

Other Services

Additional Fees

Additional Fee #1 — Description

Additional Fee #1 — Amount

$

Additional Fee #2 — Description

Additional Fee #2 — Amount

$

Additional Fee #3 — Description

Additional Fee #3 — Amount

$

Cancellation & Notes

Cancellation Policy

Other Program Costs and Pricing Notes

Step 3 of 6

Emergency Contacts

Provide 24/7 reachable emergency contacts for your agency.

Agency Code

Primary Emergency Contact Reachable 24/7

Contact Name *

Title

Email Address *

Work Phone #

Mobile Phone # *

Secondary Emergency Contact Reachable 24/7

Contact Name *

Title

Email Address

Work Phone #

Mobile Phone # *

Step 4 of 6

U.S. Host Employer Relationships

List all U.S. host employers your agency has established relationships with.

Step 5 of 6

Third-Party Service Providers

Declare all third-party relationships including tax service providers and other service partners.

A) Tax Service Providers

B) Other Third-Party Relationships

Step 6 of 6

Review & Submit

Review all information below. Click any section heading to go back and edit.

Participant Fee Agreement

I confirm that I have reviewed the complete pricing information in this document and fully understood the costs of the program. All information provided is accurate and complete to the best of my knowledge.

Printed Name *

Date

I agree to the above statement and confirm all information is accurate.