Assessment Form

Personal

Full Name*

Date of Birth*

Citizenship*

Current Country of Residence*

Email Address*

Phone Number*

Marital Status*

Number of Children and Ages*

Professional

Current Occupation/ Position Title*

How long have you been in this occupation and how many hours per week do you work?*

Education*

English Proficiency*

French Proficiency*

Do you have a job offer from a Canadian employer?*

To do

What would you like to do in Canada?*

Which province do you plan to settle in? *

Have you ever visited Canada in the past? If yes, which cities and when?*

What is the approximate amount of money you have available for your objective of immigrating, studying or travelling to Canada?*

Do you have any family in Canada (Citizens or Permanent Residents)? If yes, where do they live and what is your relationship with them?*

Do you have any existing medical condition or criminal history? If yes, please describe.*

How did you hear about us?*

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The personal information you provide to Integra Canadian Immigration Services is secure and is collected with the sole purpose of assessing your potential to immigrate/study in Canada under the current Canadian immigration/academic selection criteria. We will respond to you only in regard to your immigration/academic evaluation. You may consult our Privacy Policy for complete details.