Newcomer Services Client Registration 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

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* 1. Last Name

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* 2. First Name

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* 3. Middle Initial

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* 4. Primary Phone Number

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* 5. Alternative Phone Number

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* 6. Email Address

Primary Mailing Address

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* 7. Unit Number

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* 8. Street Number

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* 9. Street Name

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* 10. City/Town

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* 11. Province

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* 12. Postal Code

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* 13. Country of birth

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* 14. Date of Birth

Date / Time

Date

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* 15. Date of arrival in Canada (if born outside Canada):

Date / Time

Date

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* 16. Gender

Male

Female

Other (please specify)

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* 17. What languages do you speak?

English

French

Other, explain

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* 18. Preferred method of communication

Phone

Mail

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* 19. Immigration status in Canada?

Permanent Resident

Convention Refugee

Protected Person

Live-in Caregivers (Temporary Workers)

Others

Specify

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* 20. I identify as

Anglophone

Francophone

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.