Free Assessment

Independent Class Assessment Form

Details of Principal Applicant

Personal

1) First Name : *

2) Middle Name :

2) Last Name : *

3) Sex :

4) Date of Birth : *

5) Country of Citizenship : *

6) Marital Status :

Contact :

7) Current Mailing Address - House/ Street Number :

8) Current Mailing Address (Continued) :

9) City / Town :

10) Province / State :

11) Country of residence :*

12) Postal / ZIP Code :

13) Telephone Country Code :*

14) Telephone City Code :*

15) Home Telephone number :

Extension (If any)

16) Alternate Telephone number :

Extension (If any)

17) Email address :*

18) Alternative email address (If any) :

Education :

19) Highest Level of College/University Education Achieved :*

IELTS :

19-A) IELTS taken :

if yes please specify the scores	Listening	Speaking	Writing	Reading
if yes please specify the scores

Language Proficiency :

20) Choice of First Language :

21) Proficiency in Language 1 :*

Read	Write


Speak	Listen

22) Proficiency in Language 2 :*

Read	Write


Speak	Listen

Employment

23) Total years of full time Employment :*

24) Current Occupation

Ties with Canada

25) Do you have arranged Employment in Canada?*

26) Have you ever studied in Canada?*

27) Have you ever worked in Canada? :*

28) Do you have close relatives in Canada? :

29) Is your relative your :

Details of Spouse / Common-law Partner

Education

30) Highest Level of College/University Education Achieved :

Ties with Canada

31) Does your spouse have arranged Employment in Canada? :

32) Has your spouse ever studied in Canada? :

33) Has your spouse ever worked in Canada? :

34) Does your spouse have close relatives in Canada?

35) The relation is your spouse's :

Details of Children

36) Total number of Children below 22 years of Age :

37) Total number of Children above 22 years of Age :