Canada Immigration Free Assessment Form

First Name:

Last Name:

Phone Number:

Email Address:

Your Age:

Marital Status:

Level of Education

English Language Proficiency

French Language Proficiency

Your Spouse Education

Your Current Occupation

Your Previous Occupation

Do you (or your spouse) have a post-secondary degree from Canada?     Yes   No

Have you (or your spouse) worked in Canada for one year or longer?       Yes   No

Do you have any relatives living in Canada?     Please select ... No Relatives in Canada My Parent(s) My Grandparent(s) My Sister or Brother My Aunt or Uncle My Niece or Nephew My Daughter or Son My Spouse or Common-Law Partner A Parent of My Spouse A Grandparent of My Spouse A Sister or Brother of My Spouse An Aunt or Uncle of My Spouse A Niece/Nephew of My Spouse A Daughter/Son of My Spouse

Did you have any business under your name during the last 5 years?        Yes   No

Your Net Assets