Intake Form

Why I am filling this information?

To serve you better, we need to register you in our system so you can access all of our services.

Client Information

First name

Last name

Date of Birth

Cell phone number

Email address

Address

City

Postal Code

Date of Arrival in Canada

The date you entered Canada

Country of Origin

The country you were born in

First/Native Language

Do you have a Open Work Permit?

Yes No

Educational Institution

The name of the institution where you study or studied

Employment Information

Are you looking for work?

Yes No

What is your desired occupation?

Availability

Please let us know what is your availability for work, include days and hours.

Information Consent

BC NSP & BC SAFE HAVEN Client Eligibility (click here to read)

I understand the client eligibility criteria and confirm that I meet the eligibility requirements for the BC Newcomer Services Program (BC NSP) and BC SAFE HAVEN.

Immigrant Services - Consent for Service (click here to read)

I understand and agree with the above and consent to receiving services from BC Newcomer Services Program (BC NSP), BC Services And Assistance For Humanitarian And Vulnerable Newcomers (BC SAFE HAVEN) and Migrant Workers Program (MWP).

Clients’ Rights & Responsibilities brochure (click to read)

I understand and have received a copy of the Clients’ Rights & Responsibilities brochure, which also includes information on confidentiality, exceptions to confidentiality and the client concerns/complaints process.

I give consent to stay connected with Options Community Services about the programs and other events and information from us, we need your agreement (consent). We respect your privacy and want to be sure that you are able to receive information that relates to your Settlement, Integration and Career development.

As part of the acceptance please write your full name below:

Your information will be encrypted.