Canadian Immigration Council

Please fill out the assessment form below. Please verify that the information you submit is correct, since your free assessment to immigrate to Canada will be based on the information you provide. The application has been divided in three simple steps for your comfort and ease.

Step One:

1. Identification:

Family name at birth:
First name:
Other names that you have used or by which you are known:
Sex:	Female Male
Age:
Date of birth:

Place of birth
City:
Province/State:
Country:

Citizenship:

2. Residence Address

Number:
Street:
City:
Province/State:
Postal Code:
Country:

Mailing address, if different

Number:
Street:
City:
Province/State:
Postal Code:
Country:

Telephone no.

Home:
Work:
E-mail address:
Other (specify):

Fax no.

Home:
Work:
Other (specify):

3. Present Marital Status

Single

Married

De facto spouse

Separated

Divorced

Marriage annuled

Widowed

If married, or de facto spouse, please specify the following:

Spouse's Surname:

Spouse's First name:

Spouse's Date of Birth:

Spouse's Age:

Spouse's Highest Level of Education:

Speciality:

Spouse's Current Occupation:

Spouse's Years of Work Experience:

Spouse's Language Skills:

	None	Beginner				Intermediate				Advanced

Spouse's French Skills:	0	1	2	3	4	5	6	7	8	9	10	11	12
Understand spoken:
Ability to speak:
Spouse's English Skills:
Understand spoken:
Ability to speak:

Have you been married more than once?

YesNo

4. Spouse or dependant children who may or may not be accompanying you. It is imperative that the principal applicant declare all the members of his family.


How many members will be accompanying you?

Family name at birth:	First Name:	Relationship:	Date of birth:	Place and country of birth: