Intake Form

Client Intake Form
Address
City
Province
Postal Code
Gender
Official Language of Preference:
Immigration Status: (Choose one)
Level of education: (Choose one)

Family Members in Canada (Spouse, Children)

Confidentiality Statement

Kamloops Immigrant Services protects personal information by following the government’s privacy laws as outlined in the Personal Information Protection Act, Bill 38: http://www.leg.bc.ca/37th4th/3rd_read/gov38-3.htm Personal Information provided to Kamloops-Cariboo Regional Immigrants Society (KCRIS) is used to meet client’s needs, statistics, evaluation of service and research by the federal/provincial government. Staff will not disclose any information without client permission unless legally obligated to do so. Completion and submission of this intake form implies consent to collecting information for these purposes.
I certify that all of the information provided herein is true and complete to the best of my knowledge. I understand that any misstatement, falsification or omission is grounds for termination of service.

Client’s Initials
How did you hear about us?
KIS hosts workshops, events and information sessions. We will keep you inform via email. You will have the option to unsubscribe if you prefer not to receive our monthly newsletter.