FREE IMMIGRATION ASSESSMENT Please take a moment to complete our assessment. If married, your spouse should also complete a form separately. Feedback will be provided by email as soon as possible. Thank you for your time. Family Name (Surname) Given Name(s) Date of Birth DD MM YYYY Sex Male Female What is your marital status? Annulled Marriage Common-Law Divorced/Separated Legally Separated Married Never Married/ Single Widowed Number of Dependent Children I Am a Citizen Of Country of Residence Address Street Address Address 2 City State / Province Postal / Zip Code Country... Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua & Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire Bosnia & Herzegovina Botswana Brazil British Indian Ocean Ter Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Cayman Islands Central African Republic Chad Channel Islands Chile China Christmas Island Cocos Island Colombia Comoros Congo Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Ter Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guyana Haiti Hawaii Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea North Korea South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malaysia Malawi Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Midway Islands Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Nambia Nauru Nepal Netherland Antilles Netherlands (Holland, Europe) Nevis New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Norway Oman Pakistan Palau Island Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Island Poland Portugal Puerto Rico Qatar Republic of Montenegro Republic of Serbia Reunion Romania Russia Rwanda St Barthelemy St Eustatius St Helena St Kitts-Nevis St Lucia St Maarten St Pierre & Miquelon St Vincent & Grenadines Saipan Samoa Samoa American San Marino Sao Tome & Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Tahiti Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad & Tobago Tunisia Turkey Turkmenistan Turks & Caicos Is Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Vietnam Virgin Islands (Brit) Virgin Islands (USA) Wake Island Wallis & Futana Is Yemen Zaire Zambia Zimbabwe Country Your Status In Country Of Residence Phone Number (Home) Skype ID E-mail Address If Inside Canada, Status In Canada Date Of Entry Education None, or less than secondary (high school) Secondary diploma (high school graduation) One-year program at a university, college, trade or technical school Two-year program at a university, college, trade or technical school Bachelors’ degree (three or more-year program at a university, college, trade, or technical school) Two or more certificates, diplomas or degrees. One must be a program of three or more years Master’s degree, or professional degree needed to practice in a licensed profession Doctoral level university Degree (PhD) Have You Taken Your IELTS/CELPIP YES NO Language Skills - English Speaking Academic Intermediate Basic Poor Listening Academic Intermediate Basic Poor Reading Academic Intermediate Basic Poor Writing Academic Intermediate Basic Poor I am Intrested In Permanent Resident Spousal Sponsorship Parental Sponsorship Work, Study, or Tourist VIsa Help Me With A Border Visa Refusal Refugee Other Do You Have Family In Canada YES NO When Would You Like Our Assistance Immediately Within A Month Within 3-6 Months Not Sure What Type Of Help Do You Need ? I want to hire an immigration consultant or a lawyer I just want information for now Briefly Describe To Us What Do You Need Help With Do You Or Your Dependents Have Any Medical Conditions? If so explain Have you ever applied for a visa to Canada ? YES NO How Did You Hear About Us ? If you're not a fish leave this field blank:
