CARMIS Smart Forms - North West Regional Immigrant Services Inc

Your Personal Details

First Name(Required)

Middle Name

Last Name

Preferred/Other Name

Date of Birth(Required)

Marital Status(Required)

Gender(Required)

Level of Education

Email Address(Required)

Phone Number(Required)

Secondary Phone

Native Language(Required)

Other Spoken Languages (if applicable)

Current Residential Address

Address(Required)

Apt/Unit #

City(Required)

Province(Required)

Postal Code(Required)

Immigration Related Information

Status in Canada(Required)

UCI/IUC (Unique Client Identifier)(Required)

UCI/IUC (Unique Client Identifier)

Country of Birth

Date of Arrival

School/Institution Name(Required)

How Did You Hear About Us

Proof of legal status in Canada

This can be a Confirmation of Permanent Residence, a Work Permit, a Refugee Claimant document, a Permanent Resident Card, etc.

If uploading a Permanent Resident Card or other two-sided document, please ensure both sides are attached.

Drop files here or

Accepted file types: pdf, docx, doc, jpg, gif, tiff, Max. file size: 10 MB, Max. files: 1.

Proof of identification

Example: Passport, Drivers License etc.

Drop files here or

Accepted file types: pdf, docx, doc, jpg, gif, tiff, Max. file size: 10 MB, Max. files: 1.

Emergency Contact Information

Full Name

Phone Number

Email

Additional information

How Can we help you?

Details of Family Members

How many members would you like to add?(Required)

Member 1

First Name(Required)

Last Name(Required)

Date of Birth(Required)
DD slash MM slash YYYY

Status in Canada(Required)

Gender(Required)

Marital Status(Required)

Relationship(Required)

UCI/IUC (Unique Client Identifier)

UCI/IUC (Unique Client Identifier)(Required)

Country of Birth

Country of Origin

Highest Level of Education

Total Years of Education

Preferred Method of Contact

Phone Number(Required)

Email(Required)

Consent Via Email

School Grade

School Name(Required)

Field Of Study

Member 2

First Name(Required)

Last Name(Required)

Date of Birth(Required)
DD slash MM slash YYYY

Status in Canada(Required)

Gender(Required)

Marital Status(Required)

Relationship(Required)

UCI/IUC (Unique Client Identifier)

UCI/IUC (Unique Client Identifier)(Required)

Country of Birth

Country of Origin

Highest Level of Education

Total Years of Education

Preferred Method of Contact

Phone Number(Required)

Email(Required)

Consent Via Email

School Grade

School Name(Required)

Field Of Study

Member 3

First Name(Required)

Last Name(Required)

Date of Birth(Required)
DD slash MM slash YYYY

Status in Canada(Required)

Gender(Required)

Marital Status(Required)

Relationship(Required)

UCI/IUC (Unique Client Identifier)

UCI/IUC (Unique Client Identifier)(Required)

Country of Birth

Country of Origin

Highest Level of Education

Total Years of Education

Preferred Method of Contact

Phone Number(Required)

Email(Required)

Consent Via Email

School Grade

School Name(Required)

Field Of Study

Member 4

First Name(Required)

Last Name(Required)

Date of Birth(Required)
DD slash MM slash YYYY

Status in Canada(Required)

Gender(Required)

Marital Status(Required)

Relationship(Required)

UCI/IUC (Unique Client Identifier)

UCI/IUC (Unique Client Identifier)(Required)

Country of Birth

Country of Origin

Highest Level of Education

Total Years of Education

Preferred Method of Contact

Phone Number(Required)

Email(Required)

Consent Via Email

School Grade

School Name(Required)

Field Of Study

Member 5

First Name(Required)

Last Name(Required)

Date of Birth(Required)
DD slash MM slash YYYY

Status in Canada(Required)

Gender(Required)

Marital Status(Required)

Relationship(Required)

UCI/IUC (Unique Client Identifier)

UCI/IUC (Unique Client Identifier)(Required)

Country of Birth

Country of Origin

Highest Level of Education

Total Years of Education

Preferred Method of Contact

Phone Number(Required)

Email(Required)

Consent Via Email

School Grade

School Name(Required)

Field Of Study

Member 6

First Name(Required)

Last Name(Required)

Date of Birth(Required)
DD slash MM slash YYYY

Status in Canada(Required)

Gender(Required)

Marital Status(Required)

Relationship(Required)

UCI/IUC (Unique Client Identifier)

UCI/IUC (Unique Client Identifier)(Required)

Country of Birth

Country of Origin

Highest Level of Education

Total Years of Education

Preferred Method of Contact

Phone Number(Required)

Email(Required)

Consent Via Email

School Grade

School Name(Required)

Field Of Study

Consents and Confidentiality Statement

I consent to your organization collecting, storing, and using my personal information for the purposes of providing services and communications related to events, workshops, and other relevant activities. I understand that appropriate security measures will be in place to protect my data from unauthorized access or misuse.

I consent to the sharing of my personal information with trusted third-party partners of your organization solely for the purpose of delivering services and communications as described. I am aware that I have the right to withdraw my consent at any time, which may impact the services provided to me.

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