To obtain a free assessment of your eligibility please ...
Free Assessment for Study in Canada
Please mention [Yes] where ever applicable in the brackets [ ] provided
|Student Assessment Form |
|Personal Information: |
|Last Name: |First Name: |Middle Name: |
| |House No: |Street: |City: |
|Mailing Address | | | |
| | | | |
| |State: |Country: |Postal Code: |
| | | | |
|Telephone |Home: |Business: |
| |Fax: |Mobile: |
| |Email: | |
| |
|Date of Birth |Day: |Month: |Year: |Sex: |
|Place of Birth |City: |State: |Country: |
|Citizenship: | |
|Passport |Passport Number: |Passport Issued on: |Passport Expires on: |
| | | | |
|Marital Status: Mention | |Engaged [ ] |Married [ ] |
|[Yes] where relevant: |Never Married | | |
| |[ ] | | |
| |Widowed [ ] |Separated [ ] |Divorced [ ] |
| |Spouse Information |
|Spouse Info: |If you are married or engaged please provide details of spouse |
|Full Name: | |
|Date of Birth |Day: |Month: |Year: |Sex: |
|Place of Birth |City: |State: |Country: |
|Citizenship: | |
|Passport |Passport Number: |Passport Issued on: |Passport will Expire on: |
| | | | |
|Occupation: | |
|Experience: | |
|Marriage Date |Day: |Month: |Year: |Place: |
| | |
| |Family Information |
|Children |Full Name |Date of Birth |Son |Daughter |
| | | |[ ] |[ ] |
| | | |[ ] |[ ] |
| | | |[ ] |[ ] |
| |Total number of Children below 22 years of Age: [___years] |
| |Total number of Children above 22 years of Age : [___years] |
| | |
| |Relatives In Canada |
|Do you/your spouse have relatives living in Canada?:Mention Yes/No: | [ ] |
|Name: |Relationship: |Status in Canada: |
| | | |
| | | |
| |Education |
|Education Info | |
|Period |Name & Address of Institutions |Courses: | % |Degree /Diploma/ Certificate |
| | | | |Issued: |
|From: |To: | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| | |
|Mention any other related Educational experience that you have in the space provided below: |
|Total Years of Education successfully completed | [_______Years] |
| | |
| |Employment |
|Work History | |
|Date |Name & Address of Employer: |City & Country: |Job Designation: |
|From: |To: | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
|Detailed Responsibilities &|List duties & responsibilities of each position at previous employment. |
|Duties: | |
|Trade or Profession |Current Occupation: |NOC Number: |
| | | |
|Job Description: |Please attach a separate sheet giving a detailed description of the job responsibilities performed by |
| |you on a day to day basis: |
|Total Work Experience: |How many years of Work experience do you have in the last 10 years? |
|Mention Yes/No: |0 [ ] |
| |1 [ ] |
| |2 [ ] |
| |3 [ ] |
| |4 & Up [ ] |
| | |
|Intended Job In Canada: | |
| |LANGUAGES |
|Language Ability |Please indicate your ability to communicate in English and French by checking the appropriate column |
| |Mention [Yes] where applicable: |
|English |Speak |Read |Write |Understand |
| |[ ] |[ ] |[ ] |[ ] |
| | |
|French |Speak |Read |Write |Understand |
| |[ ] |[ ] |[ ] |[ ] |
| | |
|Language Test |Have you or could you pass a formal English/French Language Test? Mention Yes / No : |
| |English: [ ] |French: [ ] |
| |Language Test Results |
|English |IELTS | | | |
|Overall Score |Listening |Reading |Writing |Speaking |
| | | | | |
|French | | | | |
|Overall Score |Listening |Reading |Writing |Speaking |
| | | | | |
|Other Tests: |GRE: |GMAT: |Other: |
| | |
| |Canada Study Plan |
|Area of Study |Desired Course of study in Canada: |
|Institution | |
| |Course Preference: Mention [Yes] where applicable: |
|Course Type |Diploma: [ ] |Bachelors: [ ] |Masters: [ ] |Doctorate: [ ] |
| | |
|Period of Study |Year: |Month: |Day: |
| | | | |
|Time Frame |Expected time frame you would like to reach Canada?: Mention [Yes] where applicable: |
| |6 Months [ ] |1 Year [ ] |1 ½ Year [ ] |2 Years [ ] |
|FINANCES: |
|Sources of Financing |Own Funds [ ] | |Relatives [ ] |Savings [ ] |
| | |Parents [ ] | | |
| |Bank Loan [ ] |Sponsorship |Scholarship [ ] |Other [ ] |
| | |[ ] | |______ |
|Settlement funds |Do you have sufficient Financial support to cover the cost of Tuition and Living expenses for the first|
| |year? Mention [Yes] where applicable: |
| |More than Cdn $ 10,000 [ ] |Over Cdn $ 20,000 [ ] |
|Cdn $ |Total Funds available for my Study & Stay in Canada. |
| | |
|Net Worth |Bank: |
| |Property: |
| |Assets: |
| |Other: |
| |Total: |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
|If others give details here: |
| |Additional Information |
|Visit Abroad |Have you ever visited abroad? If yes which countries? |
| |[ ] |
| |[ ] |
| |[ ] |
| |[ ] |
| | |
| | |
| |For which countries do you have a valid visitors visa? |
| |[ ] |
| |[ ] |
| |[ ] |
| |[ ] |
| | |
| | |
| |Do you have a work visa for any country? |
| |[ ] |
| |[ ] |
| |[ ] |
| |[ ] |
| | |
| | |
| |PRIOR APPLICATION TO CANADA |
| |Have you ever visited Canada? Mention Yes / No | [ ] |
|Who did you visit |Where: |When: |Purpose: |
| | | | |
| |Have you ever studied in Canada? Mention Yes / No: | [ ] |
|If yes, give details: |Name of Institution: |Course of study: |Date: |
| | | | |
| |Have you ever worked in Canada? Mention Yes / No: | [ ] |
|If yes, give details: |Name of Employer: |Occupation: |Date: |
| | |
|Have you ever been refused a Visa? Mention Yes / No: | [ ] |
|If yes, provide details: |
|Why Canada? |Briefly explain your interest of Studying in Canada?: |
| | |
|Would you be interested in becoming a Permanent Resident in Canada after your study?: Mention Yes / No / Not Sure. [ ] |
|Other Comments |Any other information you believe that is relevant to this assessment? |
| | |
|Why Us? | |
|How did you come to know about our Immigration Consultancy firm? Mention [Yes] where applicable: |
|Referral [ ] |Friend [ ] |Seminar [ ] |
|Newspaper [ ] |Internet [ ] |Other [ ] _________ |
| |PASTE RESUME HERE (Optional) |
| |
|In addition to the Assessment form you may send an updated Resume or Curriculum vitae, if available, as an attachment to our email |
|info@ |
|DECLARATION | |
| |
|I agree that the information furnished by me in the above form is true and correct, to the best of my knowledge, and given for the |
|sole purpose of my FREE assessment regarding Studying in Canada. (YES/NO) |
| |
|Date: |
|Place: |
| |
| |
|All information provided in this form will remain strictly confidential and secure. It will not be shared with any external |
|sources. This information is used for the sole purpose of preliminary assessment of your chances to successfully immigrate to |
|Canada. Please see our Privacy Policy. |
| |
|Thank You! |Information provided to our firm is strictly Private & Confidential. |
| |
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