{"id":7522,"date":"2022-01-07T13:57:06","date_gmt":"2022-01-07T21:57:06","guid":{"rendered":"https:\/\/immigrantservices.ca\/?page_id=7522"},"modified":"2024-07-24T07:53:31","modified_gmt":"2024-07-24T15:53:31","slug":"en-route-registration-form","status":"publish","type":"page","link":"https:\/\/immigrantservices.ca\/fr\/en-route-registration-form\/","title":{"rendered":"En Route Registration Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"7522\" class=\"elementor elementor-7522\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-138beda elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"138beda\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[{&quot;jet_parallax_layout_image&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;_id&quot;:&quot;0870c08&quot;,&quot;jet_parallax_layout_image_tablet&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_image_mobile&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_speed&quot;:{&quot;unit&quot;:&quot;%&quot;,&quot;size&quot;:50,&quot;sizes&quot;:[]},&quot;jet_parallax_layout_type&quot;:&quot;scroll&quot;,&quot;jet_parallax_layout_direction&quot;:&quot;1&quot;,&quot;jet_parallax_layout_fx_direction&quot;:null,&quot;jet_parallax_layout_z_index&quot;:0,&quot;jet_parallax_layout_bg_x&quot;:50,&quot;jet_parallax_layout_bg_x_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y&quot;:50,&quot;jet_parallax_layout_bg_y_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size&quot;:&quot;auto&quot;,&quot;jet_parallax_layout_bg_size_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_animation_prop&quot;:&quot;transform&quot;,&quot;jet_parallax_layout_on&quot;:[&quot;desktop&quot;,&quot;tablet&quot;]}]}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-0db2625\" data-id=\"0db2625\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c8ba08a elementor-widget elementor-widget-heading\" data-id=\"c8ba08a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-xl\">Achieve Program<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-91aca2b elementor-widget elementor-widget-heading\" data-id=\"91aca2b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-large\">Registration Form<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-456a66d elementor-widget elementor-widget-formidable\" data-id=\"456a66d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"formidable.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<link rel='stylesheet' id='formidable-css' href='https:\/\/immigrantservices.ca\/wp-content\/plugins\/formidable\/css\/formidableforms.css?ver=20261022214921' media='all' \/>\n<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_44_container\" data-token=\"4d3aab3de238013dc5fce617cf8301ff\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_enrouteregistrationform\" data-frm-error-config=\"{&quot;includeAlertRole&quot;:false,&quot;focusFirstError&quot;:false,&quot;focusErrorSummary&quot;:true}\" data-token=\"4d3aab3de238013dc5fce617cf8301ff\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">En Route Registration Form<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"44\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_44\" id=\"frm_hide_fields_44\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"enrouteregistrationform\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_44\" name=\"frm_submit_entry_44\" value=\"813d187646\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/fr\/wp-json\/wp\/v2\/pages\/7522\" \/><div id=\"frm_field_706_container\" class=\"frm_form_field  frm_html_container form-field\">This form is intended for the use by community members to refer individuals and families to KIS En Route program, and also for individuals and families to self-refer themselves for services. The services are only available to refugees, immigrants and a limited number of temporary foreign workers, international students and citizens who face multiple barriers to their settlement.\u00a0 If they do not meet specific eligibility criteria they will not be considered for service with this program and will be referred to appropriate services.\u00a0 Meeting these minimum criteria does not guarantee services or immediate services.<\/div>\n<div id=\"frm_field_707_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\"><span>Referring Agency Information<\/span><\/h3>\r\n\r\n\r\n<div id=\"frm_field_715_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_cp74x\" id=\"field_cp74x_label\" class=\"frm_primary_label\">Name of the Referring Agency (if applicable):\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_cp74x\" name=\"item_meta[715]\" value=\"\"  data-sectionid=\"707\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_752_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_afyel\" id=\"field_afyel_label\" class=\"frm_primary_label\">Date of Referral:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_afyel\" name=\"item_meta[752]\" value=\"\"  data-sectionid=\"707\"  maxlength=\"10\" placeholder=\"mm\/dd\/yyyy\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_716_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_2h1lz\" id=\"field_2h1lz_label\" class=\"frm_primary_label\">Name of  referring Individual or Agency Staff:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_2h1lz\" name=\"item_meta[716]\" value=\"\"  data-sectionid=\"707\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_717_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_q447w\" id=\"field_q447w_label\" class=\"frm_primary_label\">Contact phone number:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_q447w\" name=\"item_meta[717]\" value=\"\"  data-sectionid=\"707\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_710_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_c1fvg\" id=\"field_c1fvg_label\" class=\"frm_primary_label\">Position (if applicable):\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_c1fvg\" name=\"item_meta[710]\" value=\"\"  data-sectionid=\"707\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_711_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_e7nw9\" id=\"field_e7nw9_label\" class=\"frm_primary_label\">Email address:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_e7nw9\" name=\"item_meta[711]\" value=\"\"  data-sectionid=\"707\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_718_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\"><span>Information of intended service recipients: <\/span><\/h3>\r\n\r\n\r\n<div id=\"frm_field_749_container\" class=\"frm_form_field form-field  frm_top_container frm4 frm_first\">\r\n    <label for=\"field_v6uqq\" id=\"field_v6uqq_label\" class=\"frm_primary_label\">First Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_v6uqq\" name=\"item_meta[749]\" value=\"\"  data-sectionid=\"718\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_750_container\" class=\"frm_form_field form-field  frm_top_container frm4\">\r\n    <label for=\"field_i0bvs\" id=\"field_i0bvs_label\" class=\"frm_primary_label\">Middle\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_i0bvs\" name=\"item_meta[750]\" value=\"\"  data-sectionid=\"718\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_751_container\" class=\"frm_form_field form-field  frm_top_container frm4\">\r\n    <label for=\"field_qmb15\" id=\"field_qmb15_label\" class=\"frm_primary_label\">Family\/Surname (Last name)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_qmb15\" name=\"item_meta[751]\" value=\"\"  data-sectionid=\"718\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_721_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <label for=\"field_fl8dr\" id=\"field_fl8dr_label\" class=\"frm_primary_label\">Date of Birth\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_fl8dr\" name=\"item_meta[721]\" value=\"\"  data-sectionid=\"718\"  maxlength=\"10\" placeholder=\"mm\/dd\/yyyy\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_722_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <div  id=\"field_z0gvp_label\" class=\"frm_primary_label\">Address\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <fieldset aria-labelledby=\"field_z0gvp_label\">\n<legend class=\"frm_screen_reader frm_hidden\">\n\tAddress<\/legend>\n<div  class=\"frm_combo_inputs_container\">\n<div id=\"frm_field_722-line1_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_z0gvp_line1\" class=\"frm_screen_reader frm_hidden\">\n\t\tAddress\t<\/label>\n\t\t<input type=\"text\" id=\"field_z0gvp_line1\" value=\"\" name=\"item_meta[722][line1]\"  data-sectionid=\"718\"  data-invmsg=\"Address est non valide\" aria-invalid=\"false\"   autocomplete=\"address-line1\" \/>\n\t<\/div>\n<div id=\"frm_field_722-line2_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_z0gvp_line2\" class=\"frm_screen_reader frm_hidden\">\n\t\tAddress\t<\/label>\n\t\t<input type=\"text\" id=\"field_z0gvp_line2\" value=\"\" name=\"item_meta[722][line2]\"  data-sectionid=\"718\"  data-invmsg=\"Address est non valide\" class=\"frm_optional\" aria-invalid=\"false\"   autocomplete=\"address-line2\" \/>\n\t<\/div>\n<div id=\"frm_field_722-city_container\" class=\"frm_form_field form-field frm_third frm_first\">\n\t<label for=\"field_z0gvp_city\" class=\"frm_screen_reader frm_hidden\">\n\t\tCity\t<\/label>\n\t\t<input type=\"text\" id=\"field_z0gvp_city\" value=\"\" name=\"item_meta[722][city]\"  data-sectionid=\"718\"  data-invmsg=\"Address est non valide\" aria-invalid=\"false\"   autocomplete=\"address-level2\" \/>\n\t<div class=\"frm_description\">City<\/div><\/div>\n<div id=\"frm_field_722-state_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_z0gvp_state\" class=\"frm_screen_reader frm_hidden\">\n\t\tState\/Province\t<\/label>\n\t\t<input type=\"text\" id=\"field_z0gvp_state\" value=\"\" name=\"item_meta[722][state]\"  data-sectionid=\"718\"  data-invmsg=\"Address est non valide\" aria-invalid=\"false\"   autocomplete=\"address-level1\" \/>\n\t<div class=\"frm_description\">State\/Province<\/div><\/div>\n<div id=\"frm_field_722-zip_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_z0gvp_zip\" class=\"frm_screen_reader frm_hidden\">\n\t\tZip\/Postal\t<\/label>\n\t\t<input type=\"text\" id=\"field_z0gvp_zip\" value=\"\" name=\"item_meta[722][zip]\"  data-sectionid=\"718\"  data-invmsg=\"Address est non valide\" aria-invalid=\"false\"   autocomplete=\"postal-code\" \/>\n\t<div class=\"frm_description\">Zip\/Postal<\/div><\/div>\n<div id=\"frm_field_722-country_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_z0gvp_country\" class=\"frm_screen_reader frm_hidden\">\n\t\tCountry\t<\/label>\n\t\t\t<select name=\"item_meta[722][country]\" id=\"field_z0gvp_country\"  data-sectionid=\"718\"  data-invmsg=\"Address est non valide\" aria-invalid=\"false\"   autocomplete=\"country-name\">\n\t\t\t<option value=\"\" class=\"\">\n\t\t\t\t \t\t\t<\/option>\n\t\t\t<option  value=\"Afghanistan\" data-code=\"AF\">Afghanistan<\/option><option  value=\"Afrique du Sud\">Afrique du Sud<\/option><option  value=\"Albanie\">Albanie<\/option><option  value=\"Alg\u00e9rie\">Alg\u00e9rie<\/option><option  value=\"Allemagne\">Allemagne<\/option><option  value=\"Andorre\">Andorre<\/option><option  value=\"Angola\" data-code=\"AO\">Angola<\/option><option  value=\"Anguilla\" data-code=\"AI\">Anguilla<\/option><option  value=\"Antarctique\">Antarctique<\/option><option  value=\"Antigua-et-Barbuda\">Antigua-et-Barbuda<\/option><option  value=\"Arabie saoudite\">Arabie saoudite<\/option><option  value=\"Argentine\">Argentine<\/option><option  value=\"Arm\u00e9nie\">Arm\u00e9nie<\/option><option  value=\"Aruba\" data-code=\"AW\">Aruba<\/option><option  value=\"Australie\">Australie<\/option><option  value=\"Autriche\">Autriche<\/option><option  value=\"Azerba\u00efdjan\">Azerba\u00efdjan<\/option><option  value=\"Bahamas\" data-code=\"BS\">Bahamas<\/option><option  value=\"Bahre\u00efn\">Bahre\u00efn<\/option><option  value=\"Bangladesh\" data-code=\"BD\">Bangladesh<\/option><option  value=\"Barbade\">Barbade<\/option><option  value=\"Belgique\">Belgique<\/option><option  value=\"Belize\" data-code=\"BZ\">Belize<\/option><option  value=\"Bermudes\">Bermudes<\/option><option  value=\"Bhoutan\">Bhoutan<\/option><option  value=\"Bi\u00e9lorussie\">Bi\u00e9lorussie<\/option><option  value=\"Bolivie\">Bolivie<\/option><option  value=\"Bonaire, Saint-Eustache et Saba\">Bonaire, Saint-Eustache et Saba<\/option><option  value=\"Bosnie-Herz\u00e9govine\">Bosnie-Herz\u00e9govine<\/option><option  value=\"Botswana\" data-code=\"BW\">Botswana<\/option><option  value=\"Brunei\" data-code=\"BN\">Brunei<\/option><option  value=\"Br\u00e9sil\">Br\u00e9sil<\/option><option  value=\"Bulgarie\">Bulgarie<\/option><option  value=\"Burkina Faso\" data-code=\"BF\">Burkina Faso<\/option><option  value=\"Burundi\" data-code=\"BI\">Burundi<\/option><option  value=\"B\u00e9nin\">B\u00e9nin<\/option><option  value=\"Cambodge\">Cambodge<\/option><option  value=\"Cameroun\">Cameroun<\/option><option  value=\"Canada\" data-code=\"CA\">Canada<\/option><option  value=\"Cap-Vert\">Cap-Vert<\/option><option  value=\"Chili\">Chili<\/option><option  value=\"Chine\">Chine<\/option><option  value=\"Chypre\">Chypre<\/option><option  value=\"Cit\u00e9 du Vatican\">Cit\u00e9 du Vatican<\/option><option  value=\"Colombie\">Colombie<\/option><option  value=\"Comores\">Comores<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Cor\u00e9e du Nord\">Cor\u00e9e du Nord<\/option><option  value=\"Cor\u00e9e du Sud\">Cor\u00e9e du Sud<\/option><option  value=\"Costa Rica\" data-code=\"CR\">Costa Rica<\/option><option  value=\"Croatie\">Croatie<\/option><option  value=\"Cuba\" data-code=\"CU\">Cuba<\/option><option  value=\"Cura\u00e7ao\">Cura\u00e7ao<\/option><option  value=\"C\u00f4te d\u2019Ivoire\">C\u00f4te d\u2019Ivoire<\/option><option  value=\"Danemark\">Danemark<\/option><option  value=\"Djibouti\" data-code=\"DJ\">Djibouti<\/option><option  value=\"Dominique\">Dominique<\/option><option  value=\"Espagne\">Espagne<\/option><option  value=\"Estonie\">Estonie<\/option><option  value=\"Eswatini\">Eswatini<\/option><option  value=\"Fidji\">Fidji<\/option><option  value=\"Finlande\">Finlande<\/option><option  value=\"France\" data-code=\"FR\">France<\/option><option  value=\"Gabon\" data-code=\"GA\">Gabon<\/option><option  value=\"Gambie\">Gambie<\/option><option  value=\"Ghana\" data-code=\"GH\">Ghana<\/option><option  value=\"Gibraltar\" data-code=\"GI\">Gibraltar<\/option><option  value=\"Grenade\">Grenade<\/option><option  value=\"Groenland\">Groenland<\/option><option  value=\"Gr\u00e8ce\">Gr\u00e8ce<\/option><option  value=\"Guadeloupe\" data-code=\"GP\">Guadeloupe<\/option><option  value=\"Guam\" data-code=\"GU\">Guam<\/option><option  value=\"Guatemala\" data-code=\"GT\">Guatemala<\/option><option  value=\"Guernesey\">Guernesey<\/option><option  value=\"Guin\u00e9e\">Guin\u00e9e<\/option><option  value=\"Guin\u00e9e \u00e9quatoriale\">Guin\u00e9e \u00e9quatoriale<\/option><option  value=\"Guin\u00e9e-Bissau\">Guin\u00e9e-Bissau<\/option><option  value=\"Guyana\" data-code=\"GY\">Guyana<\/option><option  value=\"Guyane\">Guyane<\/option><option  value=\"G\u00e9orgie\">G\u00e9orgie<\/option><option  value=\"G\u00e9orgie du Sud-et-les \u00eeles Sandwich du Sud\">G\u00e9orgie du Sud-et-les \u00eeles Sandwich du Sud<\/option><option  value=\"Ha\u00efti\">Ha\u00efti<\/option><option  value=\"Honduras\" data-code=\"HN\">Honduras<\/option><option  value=\"Hong Kong\" data-code=\"HK\">Hong Kong<\/option><option  value=\"Hongrie\">Hongrie<\/option><option  value=\"Inde\">Inde<\/option><option  value=\"Indon\u00e9sie\">Indon\u00e9sie<\/option><option  value=\"Iran\" data-code=\"IR\">Iran<\/option><option  value=\"Iraq\" data-code=\"IQ\">Iraq<\/option><option  value=\"Irlande\">Irlande<\/option><option  value=\"Islande\">Islande<\/option><option  value=\"Isra\u00ebl\">Isra\u00ebl<\/option><option  value=\"Italie\">Italie<\/option><option  value=\"Jama\u00efque\">Jama\u00efque<\/option><option  value=\"Japon\">Japon<\/option><option  value=\"Jersey\" data-code=\"JE\">Jersey<\/option><option  value=\"Jordanie\">Jordanie<\/option><option  value=\"Kazakhstan\" data-code=\"KZ\">Kazakhstan<\/option><option  value=\"Kenya\" data-code=\"KE\">Kenya<\/option><option  value=\"Kirghizistan\">Kirghizistan<\/option><option  value=\"Kiribati\" data-code=\"KI\">Kiribati<\/option><option  value=\"Kosovo\" data-code=\"XK\">Kosovo<\/option><option  value=\"Kowe\u00eft\">Kowe\u00eft<\/option><option  value=\"La R\u00e9union\">La R\u00e9union<\/option><option  value=\"Laos\" data-code=\"LA\">Laos<\/option><option  value=\"Lesotho\" data-code=\"LS\">Lesotho<\/option><option  value=\"Lettonie\">Lettonie<\/option><option  value=\"Liban\">Liban<\/option><option  value=\"Libye\">Libye<\/option><option  value=\"Lib\u00e9ria\">Lib\u00e9ria<\/option><option  value=\"Liechtenstein\" data-code=\"LI\">Liechtenstein<\/option><option  value=\"Lituanie\">Lituanie<\/option><option  value=\"Luxembourg\" data-code=\"LU\">Luxembourg<\/option><option  value=\"Macao\" data-code=\"MO\">Macao<\/option><option  value=\"Mac\u00e9doine\">Mac\u00e9doine<\/option><option  value=\"Madagascar\" data-code=\"MG\">Madagascar<\/option><option  value=\"Malaisie\">Malaisie<\/option><option  value=\"Malawi\" data-code=\"MW\">Malawi<\/option><option  value=\"Maldives\" data-code=\"MV\">Maldives<\/option><option  value=\"Mali\" data-code=\"ML\">Mali<\/option><option  value=\"Malte\">Malte<\/option><option  value=\"Maroc\">Maroc<\/option><option  value=\"Martinique\" data-code=\"MQ\">Martinique<\/option><option  value=\"Mauritanie\">Mauritanie<\/option><option  value=\"Mayotte\" data-code=\"YT\">Mayotte<\/option><option  value=\"Mexique\">Mexique<\/option><option  value=\"Micron\u00e9sie\">Micron\u00e9sie<\/option><option  value=\"Moldavie\">Moldavie<\/option><option  value=\"Monaco\" data-code=\"MC\">Monaco<\/option><option  value=\"Mongolie\">Mongolie<\/option><option  value=\"Montserrat\" data-code=\"MS\">Montserrat<\/option><option  value=\"Mont\u00e9n\u00e9gro\">Mont\u00e9n\u00e9gro<\/option><option  value=\"Mozambique\" data-code=\"MZ\">Mozambique<\/option><option  value=\"Myanmar\" data-code=\"MM\">Myanmar<\/option><option  value=\"Namibie\">Namibie<\/option><option  value=\"Nauru\" data-code=\"NR\">Nauru<\/option><option  value=\"Nicaragua\" data-code=\"NI\">Nicaragua<\/option><option  value=\"Niger\" data-code=\"NE\">Niger<\/option><option  value=\"Nig\u00e9ria\">Nig\u00e9ria<\/option><option  value=\"Niue\" data-code=\"NU\">Niue<\/option><option  value=\"Norv\u00e8ge\">Norv\u00e8ge<\/option><option  value=\"Nouvelle-Cal\u00e9donie\">Nouvelle-Cal\u00e9donie<\/option><option  value=\"Nouvelle-Z\u00e9lande\">Nouvelle-Z\u00e9lande<\/option><option  value=\"N\u00e9pal\">N\u00e9pal<\/option><option  value=\"Oman\" data-code=\"OM\">Oman<\/option><option  value=\"Ouganda\">Ouganda<\/option><option  value=\"Ouzb\u00e9kistan\">Ouzb\u00e9kistan<\/option><option  value=\"Pakistan\" data-code=\"PK\">Pakistan<\/option><option  value=\"Palaos\">Palaos<\/option><option  value=\"Palestine\">Palestine<\/option><option  value=\"Panama\" data-code=\"PA\">Panama<\/option><option  value=\"Papouasie-Nouvelle-Guin\u00e9e\">Papouasie-Nouvelle-Guin\u00e9e<\/option><option  value=\"Paraguay\" data-code=\"PY\">Paraguay<\/option><option  value=\"Pays-Bas\">Pays-Bas<\/option><option  value=\"Philippines\" data-code=\"PH\">Philippines<\/option><option  value=\"Pitcairn\" data-code=\"PN\">Pitcairn<\/option><option  value=\"Pologne\">Pologne<\/option><option  value=\"Polyn\u00e9sie fran\u00e7aise\">Polyn\u00e9sie fran\u00e7aise<\/option><option  value=\"Porto Rico\">Porto Rico<\/option><option  value=\"Portugal\" data-code=\"PT\">Portugal<\/option><option  value=\"P\u00e9rou\">P\u00e9rou<\/option><option  value=\"Qatar\" data-code=\"QA\">Qatar<\/option><option  value=\"Roumanie\">Roumanie<\/option><option  value=\"Royaume-Uni\">Royaume-Uni<\/option><option  value=\"Russie\">Russie<\/option><option  value=\"Rwanda\" data-code=\"RW\">Rwanda<\/option><option  value=\"R\u00e9publique centrafricaine\">R\u00e9publique centrafricaine<\/option><option  value=\"R\u00e9publique dominicaine\">R\u00e9publique dominicaine<\/option><option  value=\"R\u00e9publique tch\u00e8que\">R\u00e9publique tch\u00e8que<\/option><option  value=\"Sahara occidental\">Sahara occidental<\/option><option  value=\"Saint Barthelemy\" data-code=\"BL\">Saint Barthelemy<\/option><option  value=\"Saint-Christophe-et-Ni\u00e9v\u00e8s\">Saint-Christophe-et-Ni\u00e9v\u00e8s<\/option><option  value=\"Saint-Marin\">Saint-Marin<\/option><option  value=\"Saint-Martin (Antilles fran\u00e7aises)\">Saint-Martin (Antilles fran\u00e7aises)<\/option><option  value=\"Saint-Martin (royaume des Pays-Bas)\">Saint-Martin (royaume des Pays-Bas)<\/option><option  value=\"Saint-Pierre-et-Miquelon\">Saint-Pierre-et-Miquelon<\/option><option  value=\"Saint-Si\u00e8ge\">Saint-Si\u00e8ge<\/option><option  value=\"Saint-Vincent-et-les-Grenadines\">Saint-Vincent-et-les-Grenadines<\/option><option  value=\"Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha\">Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha<\/option><option  value=\"Sainte-Lucie\">Sainte-Lucie<\/option><option  value=\"Salvador\">Salvador<\/option><option  value=\"Samoa\" data-code=\"WS\">Samoa<\/option><option  value=\"Samoa am\u00e9ricaines\">Samoa am\u00e9ricaines<\/option><option  value=\"Sao Tom\u00e9-et-Principe\">Sao Tom\u00e9-et-Principe<\/option><option  value=\"Serbie\">Serbie<\/option><option  value=\"Seychelles\" data-code=\"SC\">Seychelles<\/option><option  value=\"Sierra Leone\" data-code=\"SL\">Sierra Leone<\/option><option  value=\"Singapour\">Singapour<\/option><option  value=\"Slovaquie\">Slovaquie<\/option><option  value=\"Slov\u00e9nie\">Slov\u00e9nie<\/option><option  value=\"Somalie\">Somalie<\/option><option  value=\"Soudan\">Soudan<\/option><option  value=\"Soudan du Sud\">Soudan du Sud<\/option><option  value=\"Sri Lanka\" data-code=\"LK\">Sri Lanka<\/option><option  value=\"Suisse\">Suisse<\/option><option  value=\"Surinam\">Surinam<\/option><option  value=\"Su\u00e8de\">Su\u00e8de<\/option><option  value=\"Svalbard et Jan Mayen\">Svalbard et Jan Mayen<\/option><option  value=\"Syrie\">Syrie<\/option><option  value=\"S\u00e9n\u00e9gal\">S\u00e9n\u00e9gal<\/option><option  value=\"Tadjikistan\">Tadjikistan<\/option><option  value=\"Tanzanie\">Tanzanie<\/option><option  value=\"Ta\u00efwan\">Ta\u00efwan<\/option><option  value=\"Tchad\">Tchad<\/option><option  value=\"Terres australes et antarctiques fran\u00e7aises\">Terres australes et antarctiques fran\u00e7aises<\/option><option  value=\"Territoire britannique de l\u2019oc\u00e9an Indien\">Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option  value=\"Tha\u00eflande\">Tha\u00eflande<\/option><option  value=\"Timor oriental\">Timor oriental<\/option><option  value=\"Timor-Oriental\">Timor-Oriental<\/option><option  value=\"Togo\" data-code=\"TG\">Togo<\/option><option  value=\"Tok\u00e9laou\">Tok\u00e9laou<\/option><option  value=\"Tonga\" data-code=\"TO\">Tonga<\/option><option  value=\"Trinit\u00e9-et-Tobago\">Trinit\u00e9-et-Tobago<\/option><option  value=\"Tunisie\">Tunisie<\/option><option  value=\"Turkm\u00e9nistan\">Turkm\u00e9nistan<\/option><option  value=\"Turquie\">Turquie<\/option><option  value=\"Tuvalu\" data-code=\"TV\">Tuvalu<\/option><option  value=\"Ukraine\" data-code=\"UA\">Ukraine<\/option><option  value=\"Uruguay\" data-code=\"UY\">Uruguay<\/option><option  value=\"Vanuatu\" data-code=\"VU\">Vanuatu<\/option><option  value=\"Vietnam\" data-code=\"VN\">Vietnam<\/option><option  value=\"V\u00e9n\u00e9zu\u00e9la\">V\u00e9n\u00e9zu\u00e9la<\/option><option  value=\"Wallis-et-Futuna\">Wallis-et-Futuna<\/option><option  value=\"Y\u00e9men\">Y\u00e9men<\/option><option  value=\"Zambie\">Zambie<\/option><option  value=\"Zimbabwe\" data-code=\"ZW\">Zimbabwe<\/option><option  value=\"\u00c9gypte\">\u00c9gypte<\/option><option  value=\"\u00c9mirats arabes unis\">\u00c9mirats arabes unis<\/option><option  value=\"\u00c9quateur\">\u00c9quateur<\/option><option  value=\"\u00c9rythr\u00e9e\">\u00c9rythr\u00e9e<\/option><option  value=\"\u00c9tats-Unis\">\u00c9tats-Unis<\/option><option  value=\"\u00c9thiopie\">\u00c9thiopie<\/option><option  value=\"\u00cele Bouvet\">\u00cele Bouvet<\/option><option  value=\"\u00cele Christmas\">\u00cele Christmas<\/option><option  value=\"\u00cele Maurice\">\u00cele Maurice<\/option><option  value=\"\u00cele Norfolk\">\u00cele Norfolk<\/option><option  value=\"\u00cele de Man\">\u00cele de Man<\/option><option  value=\"\u00celes Ca\u00efmans\">\u00celes Ca\u00efmans<\/option><option  value=\"\u00celes Cocos\">\u00celes Cocos<\/option><option  value=\"\u00celes Cook\">\u00celes Cook<\/option><option  value=\"\u00celes Falkland\">\u00celes Falkland<\/option><option  value=\"\u00celes F\u00e9ro\u00e9\">\u00celes F\u00e9ro\u00e9<\/option><option  value=\"\u00celes Heard-et-MacDonald\">\u00celes Heard-et-MacDonald<\/option><option  value=\"\u00celes Malouines (Falkland)\">\u00celes Malouines (Falkland)<\/option><option  value=\"\u00celes Mariannes du Nord\">\u00celes Mariannes du Nord<\/option><option  value=\"\u00celes Marshall\">\u00celes Marshall<\/option><option  value=\"\u00celes Salomon\">\u00celes Salomon<\/option><option  value=\"\u00celes Turques-et-Ca\u00efques\">\u00celes Turques-et-Ca\u00efques<\/option><option  value=\"\u00celes Vierges britanniques\">\u00celes Vierges britanniques<\/option><option  value=\"\u00celes Vierges des \u00c9tats-Unis\">\u00celes Vierges des \u00c9tats-Unis<\/option><option  value=\"\u00celes mineures \u00e9loign\u00e9es des \u00c9tats-Unis\">\u00celes mineures \u00e9loign\u00e9es des \u00c9tats-Unis<\/option>\t\t<\/select>\n\t<div class=\"frm_description\">Country<\/div><\/div>\n<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_723_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_kod8t\" id=\"field_kod8t_label\" class=\"frm_primary_label\">Phone\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_kod8t\" name=\"item_meta[723]\" value=\"\"  data-sectionid=\"718\"  data-invmsg=\"Phone is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_724_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_i545p\" id=\"field_i545p_label\" class=\"frm_primary_label\">Email\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_i545p\" name=\"item_meta[724]\" value=\"\"  data-sectionid=\"718\"  data-invmsg=\"Email is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_725_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_snxv8\" id=\"field_snxv8_label\" class=\"frm_primary_label\">Country of Origin\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_snxv8\" name=\"item_meta[725]\" value=\"\"  data-sectionid=\"718\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_726_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_f2rbs\" id=\"field_f2rbs_label\" class=\"frm_primary_label\">Date of arrival in Canada\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_f2rbs\" name=\"item_meta[726]\" value=\"\"  data-sectionid=\"718\"  maxlength=\"10\" placeholder=\"mm\/dd\/yyyy\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_727_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_ozm2x\" id=\"field_ozm2x_label\" class=\"frm_primary_label\">First Language\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_ozm2x\" name=\"item_meta[727]\" value=\"\"  data-sectionid=\"718\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_728_container\" class=\"frm_form_field form-field  frm_top_container frm6 vertical_radio\">\r\n    <div  id=\"field_uwkb_label\" class=\"frm_primary_label\">Preferred Official Language\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_uwkb_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_728-718-0\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[728][]\" id=\"field_uwkb-0\" value=\"English\"  data-sectionid=\"718\"  data-invmsg=\"Preferred Official Language est non valide\"   \/> English<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_728-718-1\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[728][]\" id=\"field_uwkb-1\" value=\"French\"  data-sectionid=\"718\"  data-invmsg=\"Preferred Official Language est non valide\"   \/> French<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_730_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p><b>No. of Family Members:<\/b><\/p>\n<\/div>\n<div id=\"frm_field_732_container\" class=\"frm_form_field form-field  frm_top_container frm3 frm_first\">\r\n    <label for=\"field_vojt3\" id=\"field_vojt3_label\" class=\"frm_primary_label\">Adults\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_vojt3\" name=\"item_meta[732]\" value=\"\"  data-sectionid=\"718\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_731_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n    <label for=\"field_ylnjd\" id=\"field_ylnjd_label\" class=\"frm_primary_label\">Young Adult (19-25) \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_ylnjd\" name=\"item_meta[731]\" value=\"\"  data-sectionid=\"718\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_729_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n    <label for=\"field_a97eo\" id=\"field_a97eo_label\" class=\"frm_primary_label\">Youth (13-18)* \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_a97eo\" name=\"item_meta[729]\" value=\"\"  data-sectionid=\"718\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_733_container\" class=\"frm_form_field form-field  frm_top_container frm3 frm3\">\r\n    <label for=\"field_1n2dl\" id=\"field_1n2dl_label\" class=\"frm_primary_label\">Children (under 12) \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_1n2dl\" name=\"item_meta[733]\" value=\"\"  data-sectionid=\"718\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_735_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first frm_two_col frm_other_container\">\r\n    <div  id=\"field_br2e9_label\" class=\"frm_primary_label\">Immigration Status (Choose one)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_br2e9_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_735-0\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[735][]\" id=\"field_br2e9-0\" value=\"Permanent Resident\"  data-frmlimit=\"1\"  data-invmsg=\"Immigration Status (Choose one) est non valide\"   \/> Permanent Resident<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_735-1\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[735][]\" id=\"field_br2e9-1\" value=\"Government-Assisted Refugee\"  data-frmlimit=\"1\"  data-invmsg=\"Immigration Status (Choose one) est non valide\"   \/> Government-Assisted Refugee<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_735-2\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[735][]\" id=\"field_br2e9-2\" value=\"Protected Person under IRPA S.95\"  data-frmlimit=\"1\"  data-invmsg=\"Immigration Status (Choose one) est non valide\"   \/> Protected Person under IRPA S.95<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_735-3\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[735][]\" id=\"field_br2e9-3\" value=\"Naturalized Canadian Citizen\"  data-frmlimit=\"1\"  data-invmsg=\"Immigration Status (Choose one) est non valide\"   \/> Naturalized Canadian Citizen<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_735-4\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[735][]\" id=\"field_br2e9-4\" value=\"Privately Sponsored Refugee\"  data-frmlimit=\"1\"  data-invmsg=\"Immigration Status (Choose one) est non valide\"   \/> Privately Sponsored Refugee<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_735-5\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[735][]\" id=\"field_br2e9-5\" value=\"International Student\"  data-frmlimit=\"1\"  data-invmsg=\"Immigration Status (Choose one) est non valide\"   \/> International Student<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_735-6\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[735][]\" id=\"field_br2e9-6\" value=\"Temporary Foreign Worker\"  data-frmlimit=\"1\"  data-invmsg=\"Immigration Status (Choose one) est non valide\"   \/> Temporary Foreign Worker<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_735-7\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[735][]\" id=\"field_br2e9-7\" value=\"Individuals selected by Canada to become a permanent resident and are pending           admissibility assessment by IRCC\"  data-frmlimit=\"1\"  data-invmsg=\"Immigration Status (Choose one) est non valide\"   \/> Individuals selected by Canada to become a permanent resident and are pending           admissibility assessment by IRCC<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_735-other_9\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[735][other_9]\" id=\"field_br2e9-other_9\" value=\"Other (please specify):\"  data-frmlimit=\"1\"  data-invmsg=\"Immigration Status (Choose one) est non valide\"   \/> Other (please specify):<\/label><label for=\"field_br2e9-other_9-otext\" class=\"frm_screen_reader frm_hidden\">Other (please specify):<\/label><input type=\"text\" id=\"field_br2e9-other_9-otext\" class=\"frm_other_input frm_pos_none\" name=\"item_meta[other][735][other_9]\" value=\"\" \/><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_740_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\"><span><b>Indicate the issues\/barriers to settlement the individual\/family is facing by checking all appropriate boxes:  <\/b><\/span><\/h3>\r\n\r\n\r\n<div id=\"frm_field_744_container\" class=\"frm_form_field form-field  frm_top_container frm4 frm_first vertical_radio\">\r\n    <div  id=\"field_e97yc_label\" class=\"frm_primary_label\"><b>Barriers to Settle in the  Community<\/b>\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_e97yc_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_744-740-0\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[744][]\" id=\"field_e97yc-0\" value=\"Lack of workplace Canadian job skills\"  data-sectionid=\"740\"  data-invmsg=\"&lt;b&gt;Barriers to Settle in the  Community&lt;\/b&gt; est non valide\"   \/> Lack of workplace Canadian job skills<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_744-740-1\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[744][]\" id=\"field_e97yc-1\" value=\"Lack of education or interrupted education\"  data-sectionid=\"740\"  data-invmsg=\"&lt;b&gt;Barriers to Settle in the  Community&lt;\/b&gt; est non valide\"   \/> Lack of education or interrupted education<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_744-740-2\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[744][]\" id=\"field_e97yc-2\" value=\"Low literacy\"  data-sectionid=\"740\"  data-invmsg=\"&lt;b&gt;Barriers to Settle in the  Community&lt;\/b&gt; est non valide\"   \/> Low literacy<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_744-740-3\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[744][]\" id=\"field_e97yc-3\" value=\"Little or no English\"  data-sectionid=\"740\"  data-invmsg=\"&lt;b&gt;Barriers to Settle in the  Community&lt;\/b&gt; est non valide\"   \/> Little or no English<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_744-740-4\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[744][]\" id=\"field_e97yc-4\" value=\"Single parent household\"  data-sectionid=\"740\"  data-invmsg=\"&lt;b&gt;Barriers to Settle in the  Community&lt;\/b&gt; est non valide\"   \/> Single parent household<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_743_container\" class=\"frm_form_field form-field  frm_top_container frm4 vertical_radio\">\r\n    <div  id=\"field_5lppt_label\" class=\"frm_primary_label\"><b>Hardships\/Difficulties<\/b>\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_5lppt_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_743-740-0\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[743][]\" id=\"field_5lppt-0\" value=\"Unfamiliar with urbanized environment and amenities\"  data-sectionid=\"740\"  data-invmsg=\"&lt;b&gt;Hardships\/Difficulties&lt;\/b&gt; est non valide\"   \/> Unfamiliar with urbanized environment and amenities<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_743-740-1\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[743][]\" id=\"field_5lppt-1\" value=\"Cultural shock or cultural dissonance\"  data-sectionid=\"740\"  data-invmsg=\"&lt;b&gt;Hardships\/Difficulties&lt;\/b&gt; est non valide\"   \/> Cultural shock or cultural dissonance<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_743-740-2\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[743][]\" id=\"field_5lppt-2\" value=\"Mental health\/chronic health issues\"  data-sectionid=\"740\"  data-invmsg=\"&lt;b&gt;Hardships\/Difficulties&lt;\/b&gt; est non valide\"   \/> Mental health\/chronic health issues<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_743-740-3\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[743][]\" id=\"field_5lppt-3\" value=\"Social isolation\"  data-sectionid=\"740\"  data-invmsg=\"&lt;b&gt;Hardships\/Difficulties&lt;\/b&gt; est non valide\"   \/> Social isolation<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_743-740-4\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[743][]\" id=\"field_5lppt-4\" value=\"Lack of financial means\"  data-sectionid=\"740\"  data-invmsg=\"&lt;b&gt;Hardships\/Difficulties&lt;\/b&gt; est non valide\"   \/> Lack of financial means<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_745_container\" class=\"frm_form_field form-field  frm_top_container frm4 vertical_radio\">\r\n    <div  id=\"field_shyn5_label\" class=\"frm_primary_label\"><b>Complex Life Situation<\/b>\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_shyn5_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_745-740-0\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[745][]\" id=\"field_shyn5-0\" value=\"Experience of violence and trauma\"  data-sectionid=\"740\"  data-invmsg=\"&lt;b&gt;Complex Life Situation&lt;\/b&gt; est non valide\"   \/> Experience of violence and trauma<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_745-740-1\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[745][]\" id=\"field_shyn5-1\" value=\"Loss of family due to migration\"  data-sectionid=\"740\"  data-invmsg=\"&lt;b&gt;Complex Life Situation&lt;\/b&gt; est non valide\"   \/> Loss of family due to migration<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_745-740-2\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[745][]\" id=\"field_shyn5-2\" value=\"Protracted refugee camp experience\"  data-sectionid=\"740\"  data-invmsg=\"&lt;b&gt;Complex Life Situation&lt;\/b&gt; est non valide\"   \/> Protracted refugee camp experience<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_745-740-3\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[745][]\" id=\"field_shyn5-3\" value=\"Large household with many children\"  data-sectionid=\"740\"  data-invmsg=\"&lt;b&gt;Complex Life Situation&lt;\/b&gt; est non valide\"   \/> Large household with many children<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_745-740-4\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[745][]\" id=\"field_shyn5-4\" value=\"Street involvement Criminal engagement\"  data-sectionid=\"740\"  data-invmsg=\"&lt;b&gt;Complex Life Situation&lt;\/b&gt; est non valide\"   \/> Street involvement Criminal engagement<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_742_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <label for=\"field_q3y7o\" id=\"field_q3y7o_label\" class=\"frm_primary_label\">Other(s) (Please Specify):\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_q3y7o\" name=\"item_meta[742]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_746_container\" class=\"frm_form_field  frm12 frm_first frm_html_container form-field\"><b>Consent to Release Information:\u00a0 <\/b>By signing below you, the <b>referred individual<\/b>, are indicating that you have given permission to the person (community or family member) to release this information to KIS for the sole purpose of determining your eligibility for En Route program.\u00a0 If you are referring yourself, your signature indicates your voluntary consent to release this information for the same purpose.\u00a0 This release will be in effect for two years from the date of signature.<\/div>\n<div id=\"frm_field_747_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_49nzf\" id=\"field_49nzf_label\" class=\"frm_primary_label\">Signature\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \t\t\t<input  type=\"hidden\" name=\"item_meta[747][delete_saved_image]\" value=\"0\" \/>\n\t\t\t\t\t\t<input  type=\"hidden\" name=\"item_meta[747][content]\" value=\"\" \/>\n\t\t\t<div class=\"sigPad\" id='sigPad747' style=\"max-width:400px;\">\n\t<div class=\"sig sigWrapper\" style=\"height:150px;border-color:#D0D5DD;--bg-color:#ffffff;--active:#4199FD;--inactive:#EAECF0;--active-text:#ffffff;--inactive-text:#1D2939;--button-margin:22px;--button-size:20px;--button-padding:10px;--button-side-margin:22px;--icon:20px\">\n\n\t\t<ul class=\"sigNav\">\n\t\t\t\t<li class=\"drawIt\">\n\t\t\t\t\t<a href=\"#\" class=\"frm-active-sig-type\" title=\"Draw It\" aria-label=\"Draw It\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>signature<\/title>\n\t<path d=\"M19.7 2.2A3.5 3.5 0 0 0 14 1.1L1.7 13.4a1 1 0 0 0-.3.4l-1.3 5a.9.9 0 0 0 0 .5 1 1 0 0 0 1 .6l5-1.3c.2 0 .4-.1.5-.3L18.9 6a3.5 3.5 0 0 0 .7-3.8zm-6.8 2.6L15.2 7l-8.6 8.7-2.4-2.4zm-10.7 13l1-3.3L5.4 17zM18 4.2l-.4.5L16.3 6 14 3.7l1.3-1.3A1.7 1.7 0 0 1 18 3.6l-.1.6zM9 17.9h11v1H9v-1z\"><\/path>\n\n<\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t\t\t<li class=\"typeIt\">\n\t\t\t\t\t<a href=\"#\" class=\"\" title=\"Type It\" aria-label=\"Type It\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>keyboard<\/title>\n\t<path d=\"M20.6 2.5H2c-1 0-1.9.8-1.9 1.9v11.2c0 1 .8 1.9 1.9 1.9h18.7c1 0 1.9-.8 1.9-1.9V4.4c0-1-.8-1.9-1.9-1.9zm.3 13.1c0 .2-.1.3-.3.3H2a.3.3 0 0 1-.3-.3V4.4c0-.2.1-.3.3-.3h18.7c.2 0 .3.1.3.3v11.2zm-14.3-5V9.4c0-.3-.2-.5-.4-.5H5c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5H9c-.3 0-.5.2-.5.5v1c0 .3.2.5.4.5H10c.3 0 .5-.2.5-.5zm3.7 0V9.4c0-.3-.2-.5-.4-.5h-1.1c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.5v1c0 .3.2.5.4.5h1.1c.3 0 .5-.2.5-.5zM4.8 7.2v-1c0-.3-.2-.5-.5-.5H3.2c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm3.7 0v-1c0-.3-.2-.5-.5-.5H7c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0v-1c0-.3-.2-.5-.5-.5h-1.1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm3.7 0v-1c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0v-1c0-.3-.2-.5-.5-.5h-1.1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm-2 6.2V13c0-.3-.2-.5-.6-.5h-12c-.3 0-.6.2-.6.5v.6c0 .3.3.5.7.5h12c.3 0 .6-.2.6-.5z\"><\/path>\n<\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t<\/ul>\n\n\t\t<span class=\"frm-typed-drawline\"><\/span>\n\n\t\t<div class=\"typed\">\n\t\t\t<input type=\"text\" name=\"item_meta[747][typed]\" class=\"name\" id=\"field_49nzf\" autocomplete=\"off\" value=\"\"  style=\"width:400px\" maxlength=\"150\" class=\"auto_width\" aria-invalid=\"false\"   \/>\n\t\t<\/div>\n\n\t\t<canvas class=\"pad\" data-fieldid=\"747\" data-fieldname=\"item_meta[747]\" width=\"396\" height=\"150\"><\/canvas>\n\t\t<div class=\"clearButton\"><a href=\"#clear\">Clear<\/a><\/div>\n\n\t\t<input type=\"hidden\" name=\"item_meta[747][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_748_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p><span style=\"color: #ff0000;\">Questions?<\/span> Feel free to email,<\/p>\n<p><span style=\"color: #ff0000;\"><em><strong>Liza Ferris\u00a0<\/strong><\/em><em><strong>at\u00a0 liza@kcris.ca<\/strong><\/em><\/span><\/p>\n<p><b>Client Confidentiality:\u00a0 <\/b>Kamloops Immigrant Services protects personal information by following the government\u2019s privacy laws as outlined in the Personal Information Protection Act, Bill 38 https:\/\/www.leg.bc.ca\/pages\/bclass-legacy.aspx#\/content\/legacy\/web\/37th4th\/3rd_read\/gov38-3.htm<\/p>\n<p><span style=\"color: #ff0000;\">KIS En Route program<\/span><br \/><span style=\"color: #ff0000;\">448 Tranquille Road, Kamloops BC V2B 3H2<\/span><\/p>\n<\/div>\n<div id=\"frm_field_987_container\" class=\"frm_form_field form-field  frm_none_container\"><div  id=\"field_thwit\" class=\"frm-g-recaptcha\" data-sitekey=\"6Lcz1pApAAAAAKDT0hdcUztSLkXkl3KyjqPEG9kZ\" data-size=\"invisible\" data-theme=\"light\"><\/div>\n    \n    \n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_1239_container\">\n\t\t\t<label for=\"field_isai0\" >\n\t\t\t\tSi vous \u00eates un humain, ne remplissez pas ce champ.\t\t\t<\/label>\n\t\t\t<input  id=\"field_isai0\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[1239]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"zrPLwZ+I1mN3lm3vGBaH5NhuQ\/x+ecQYptrmS6HQ6b3dc3z40NaUjeiveJ\/qLzYW\" \/><div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Submit<\/button>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Achieve Program Registration Form En Route Registration Form This form is intended for the use by community members to refer individuals and families to KIS En Route program, and also [&hellip;]<\/p>\n","protected":false},"author":25,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_mo_disable_npp":"","_price":"","_stock":"","_tribe_ticket_header":"","_tribe_default_ticket_provider":"","_tribe_ticket_capacity":"0","_ticket_start_date":"","_ticket_end_date":"","_tribe_ticket_show_description":"","_tribe_ticket_show_not_going":false,"_tribe_ticket_use_global_stock":"","_tribe_ticket_global_stock_level":"","_global_stock_mode":"","_global_stock_cap":"","_tribe_rsvp_for_event":"","_tribe_ticket_going_count":"","_tribe_ticket_not_going_count":"","_tribe_tickets_list":"[]","_tribe_ticket_has_attendee_info_fields":false,"footnotes":"","_tec_slr_enabled":"","_tec_slr_layout":"","_wp_rev_ctl_limit":""},"class_list":["post-7522","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>En Route Registration Form - Kamloops Immigrant Services<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/immigrantservices.ca\/fr\/en-route-registration-form\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"En Route Registration Form - Kamloops Immigrant Services\" \/>\n<meta property=\"og:description\" content=\"Achieve Program Registration Form En Route Registration Form This form is intended for the use by community members to refer individuals and families to KIS En Route program, and also [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/immigrantservices.ca\/fr\/en-route-registration-form\/\" \/>\n<meta property=\"og:site_name\" content=\"Kamloops Immigrant Services\" \/>\n<meta property=\"article:modified_time\" content=\"2024-07-24T15:53:31+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data1\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/immigrantservices.ca\\\/en-route-registration-form\\\/\",\"url\":\"https:\\\/\\\/immigrantservices.ca\\\/en-route-registration-form\\\/\",\"name\":\"En Route Registration Form - Kamloops Immigrant 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