CCIS Alberta - How can we help you?

You may fill out the on-line form below, and click "submit." We will connect you with someone who can help.

	CCIS Intake Form - Word Version
	CCIS Intake Form - PDF Version

INTAKE FORM

Family Name(*)

Please let us know your name.

Given/First Name

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Date of arrival in Canada

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From what country?(*)

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Immigration Status(*)

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Current address(*)

Please let us know your message.

Cell Phone Number

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E-mail address(*)

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Language Spoken

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Date of Birth

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Gender

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Other

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Marital Status(*)

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Number of immediate family members (spouse, children)

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Have you been to CCIS before?(*)

YesNo

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If yes-who is your counsellor?

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Note: When we speak with you directly, we will require your Social Insurance number and your FOSS ID number.

How can we help you?

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Captcha(*)

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