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Newcomers Service Request Form
PROTECTED B WHEN COMPLETED
Please fill up the form and PCPI will contact you within 2 business days to discuss your requirements and/or acceptance into the program.
Thank you.
Personal Information
*
1.
Last Name
(Required.)
*
2.
First Name
(Required.)
3.
Middle Initial
4.
Gender
Male
Female
Other (please specify)
*
5.
Primary Phone Number
(Required.)
6.
Alternative Phone Number
*
7.
Email Address
(Required.)
Primary Mailing Address
*
8.
Street Number
(Required.)
*
9.
Street Name
(Required.)
*
10.
City/Town
(Required.)
*
11.
Province
(Required.)
*
12.
Postal Code
(Required.)
*
13.
Country of birth
(Required.)
14.
Date of Birth
Date / Time
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
*
15.
Immigration status in Canada?
(Required.)
Permanent Resident
Convention Refugee
Protected Person
Live-in Caregivers (Temporary Workers)
Others
Specify
16.
How long are you in permanent resident status?
6 years or less
More than 6 years
Do not have permanent resident status
Other, explain
17.
PR Card / UCI Number
18.
Current employment status?
Employed in their field of study
Employed in other field of study
Unemployed
Other, explain
19.
Intended occupation
*
20.
I identify as
(Required.)
Anglophone
Francophone
*
21.
What languages do you speak?
(Required.)
English
French
Other, explain
*
22.
Preferred method of communication
(Required.)
Phone
Email
Mail
Thank you for completing the TENS registration form, your information will be kept confidential and will not be shared with any parties outside of the organization, it will ONLY be used to assess your eligibility for this program.
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