{"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\/pa\/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=\"\/pa\/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 is invalid\" 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 is invalid\" 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 is invalid\" 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 is invalid\" 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 is invalid\" 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 is invalid\" 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=\"Aland Islands\" data-code=\"AX\">Aland Islands<\/option><option  value=\"Albania\" data-code=\"AL\">Albania<\/option><option  value=\"Algeria\" data-code=\"DZ\">Algeria<\/option><option  value=\"American Samoa\" data-code=\"AS\">American Samoa<\/option><option  value=\"Andorra\" data-code=\"AD\">Andorra<\/option><option  value=\"Angola\" data-code=\"AO\">Angola<\/option><option  value=\"Anguilla\" data-code=\"AI\">Anguilla<\/option><option  value=\"Antarctica\" data-code=\"AQ\">Antarctica<\/option><option  value=\"Antigua and Barbuda\" data-code=\"AG\">Antigua and Barbuda<\/option><option  value=\"Argentina\" data-code=\"AR\">Argentina<\/option><option  value=\"Armenia\" data-code=\"AM\">Armenia<\/option><option  value=\"Aruba\" data-code=\"AW\">Aruba<\/option><option  value=\"Australia\" data-code=\"AU\">Australia<\/option><option  value=\"Austria\" data-code=\"AT\">Austria<\/option><option  value=\"Azerbaijan\" data-code=\"AZ\">Azerbaijan<\/option><option  value=\"Bahamas\" data-code=\"BS\">Bahamas<\/option><option  value=\"Bahrain\" data-code=\"BH\">Bahrain<\/option><option  value=\"Bangladesh\" data-code=\"BD\">Bangladesh<\/option><option  value=\"Barbados\" data-code=\"BB\">Barbados<\/option><option  value=\"Belarus\" data-code=\"BY\">Belarus<\/option><option  value=\"Belgium\" data-code=\"BE\">Belgium<\/option><option  value=\"Belize\" data-code=\"BZ\">Belize<\/option><option  value=\"Benin\" data-code=\"BJ\">Benin<\/option><option  value=\"Bermuda\" data-code=\"BM\">Bermuda<\/option><option  value=\"Bhutan\" data-code=\"BT\">Bhutan<\/option><option  value=\"Bolivia\" data-code=\"BO\">Bolivia<\/option><option  value=\"Bonaire, Sint Eustatius and Saba\">Bonaire, Sint Eustatius and Saba<\/option><option  value=\"Bosnia and Herzegovina\" data-code=\"BA\">Bosnia and Herzegovina<\/option><option  value=\"Botswana\" data-code=\"BW\">Botswana<\/option><option  value=\"Bouvet Island\" data-code=\"BV\">Bouvet Island<\/option><option  value=\"Brazil\" data-code=\"BR\">Brazil<\/option><option  value=\"British Indian Ocean Territory\" data-code=\"IO\">British Indian Ocean Territory<\/option><option  value=\"Brunei\" data-code=\"BN\">Brunei<\/option><option  value=\"Bulgaria\" data-code=\"BG\">Bulgaria<\/option><option  value=\"Burkina Faso\" data-code=\"BF\">Burkina Faso<\/option><option  value=\"Burundi\" data-code=\"BI\">Burundi<\/option><option  value=\"C&ocirc;te d&#039;Ivoire\">C&ocirc;te d&#039;Ivoire<\/option><option  value=\"Cambodia\" data-code=\"KH\">Cambodia<\/option><option  value=\"Cameroon\" data-code=\"CM\">Cameroon<\/option><option  value=\"Canada\" data-code=\"CA\">Canada<\/option><option  value=\"Cape Verde\" data-code=\"CV\">Cape Verde<\/option><option  value=\"Cayman Islands\" data-code=\"KY\">Cayman Islands<\/option><option  value=\"Central African Republic\" data-code=\"CF\">Central African Republic<\/option><option  value=\"Chad\" data-code=\"TD\">Chad<\/option><option  value=\"Chile\" data-code=\"CL\">Chile<\/option><option  value=\"China\" data-code=\"CN\">China<\/option><option  value=\"Christmas Island\" data-code=\"CX\">Christmas Island<\/option><option  value=\"Cocos (Keeling) Islands\">Cocos (Keeling) Islands<\/option><option  value=\"Colombia\" data-code=\"CO\">Colombia<\/option><option  value=\"Comoros\" data-code=\"KM\">Comoros<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Cook Islands\" data-code=\"CK\">Cook Islands<\/option><option  value=\"Costa Rica\" data-code=\"CR\">Costa Rica<\/option><option  value=\"Croatia\" data-code=\"HR\">Croatia<\/option><option  value=\"Cuba\" data-code=\"CU\">Cuba<\/option><option  value=\"Curacao\" data-code=\"CW\">Curacao<\/option><option  value=\"Cyprus\" data-code=\"CY\">Cyprus<\/option><option  value=\"Czech Republic\" data-code=\"CZ\">Czech Republic<\/option><option  value=\"Denmark\" data-code=\"DK\">Denmark<\/option><option  value=\"Djibouti\" data-code=\"DJ\">Djibouti<\/option><option  value=\"Dominica\" data-code=\"DM\">Dominica<\/option><option  value=\"Dominican Republic\" data-code=\"DO\">Dominican Republic<\/option><option  value=\"East Timor\" data-code=\"TL\">East Timor<\/option><option  value=\"Ecuador\" data-code=\"EC\">Ecuador<\/option><option  value=\"Egypt\" data-code=\"EG\">Egypt<\/option><option  value=\"El Salvador\" data-code=\"SV\">El Salvador<\/option><option  value=\"Equatorial Guinea\" data-code=\"GQ\">Equatorial Guinea<\/option><option  value=\"Eritrea\" data-code=\"ER\">Eritrea<\/option><option  value=\"Estonia\" data-code=\"EE\">Estonia<\/option><option  value=\"Ethiopia\" data-code=\"ET\">Ethiopia<\/option><option  value=\"Falkland Islands (Malvinas)\">Falkland Islands (Malvinas)<\/option><option  value=\"Faroe Islands\" data-code=\"FO\">Faroe Islands<\/option><option  value=\"Fiji\" data-code=\"FJ\">Fiji<\/option><option  value=\"Finland\" data-code=\"FI\">Finland<\/option><option  value=\"France\" data-code=\"FR\">France<\/option><option  value=\"French Guiana\" data-code=\"GF\">French Guiana<\/option><option  value=\"French Polynesia\" data-code=\"PF\">French Polynesia<\/option><option  value=\"French Southern Territories\" data-code=\"TF\">French Southern Territories<\/option><option  value=\"Gabon\" data-code=\"GA\">Gabon<\/option><option  value=\"Gambia\" data-code=\"GM\">Gambia<\/option><option  value=\"Georgia\" data-code=\"GE\">Georgia<\/option><option  value=\"Germany\" data-code=\"DE\">Germany<\/option><option  value=\"Ghana\" data-code=\"GH\">Ghana<\/option><option  value=\"Gibraltar\" data-code=\"GI\">Gibraltar<\/option><option  value=\"Greece\" data-code=\"GR\">Greece<\/option><option  value=\"Greenland\" data-code=\"GL\">Greenland<\/option><option  value=\"Grenada\" data-code=\"GD\">Grenada<\/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=\"Guernsey\" data-code=\"GG\">Guernsey<\/option><option  value=\"Guinea\" data-code=\"GN\">Guinea<\/option><option  value=\"Guinea-Bissau\" data-code=\"GW\">Guinea-Bissau<\/option><option  value=\"Guyana\" data-code=\"GY\">Guyana<\/option><option  value=\"Haiti\" data-code=\"HT\">Haiti<\/option><option  value=\"Heard Island and McDonald Islands\" data-code=\"HM\">Heard Island and McDonald Islands<\/option><option  value=\"Holy See\">Holy See<\/option><option  value=\"Honduras\" data-code=\"HN\">Honduras<\/option><option  value=\"Hong Kong\" data-code=\"HK\">Hong Kong<\/option><option  value=\"Hungary\" data-code=\"HU\">Hungary<\/option><option  value=\"Iceland\" data-code=\"IS\">Iceland<\/option><option  value=\"India\" data-code=\"IN\">India<\/option><option  value=\"Indonesia\" data-code=\"ID\">Indonesia<\/option><option  value=\"Iran\" data-code=\"IR\">Iran<\/option><option  value=\"Iraq\" data-code=\"IQ\">Iraq<\/option><option  value=\"Ireland\" data-code=\"IE\">Ireland<\/option><option  value=\"Isle of Man\" data-code=\"IM\">Isle of Man<\/option><option  value=\"Israel\" data-code=\"IL\">Israel<\/option><option  value=\"Italy\" data-code=\"IT\">Italy<\/option><option  value=\"Jamaica\" data-code=\"JM\">Jamaica<\/option><option  value=\"Japan\" data-code=\"JP\">Japan<\/option><option  value=\"Jersey\" data-code=\"JE\">Jersey<\/option><option  value=\"Jordan\" data-code=\"JO\">Jordan<\/option><option  value=\"Kazakhstan\" data-code=\"KZ\">Kazakhstan<\/option><option  value=\"Kenya\" data-code=\"KE\">Kenya<\/option><option  value=\"Kiribati\" data-code=\"KI\">Kiribati<\/option><option  value=\"Kosovo\" data-code=\"XK\">Kosovo<\/option><option  value=\"Kuwait\" data-code=\"KW\">Kuwait<\/option><option  value=\"Kyrgyzstan\" data-code=\"KG\">Kyrgyzstan<\/option><option  value=\"Laos\" data-code=\"LA\">Laos<\/option><option  value=\"Latvia\" data-code=\"LV\">Latvia<\/option><option  value=\"Lebanon\" data-code=\"LB\">Lebanon<\/option><option  value=\"Lesotho\" data-code=\"LS\">Lesotho<\/option><option  value=\"Liberia\" data-code=\"LR\">Liberia<\/option><option  value=\"Libya\" data-code=\"LY\">Libya<\/option><option  value=\"Liechtenstein\" data-code=\"LI\">Liechtenstein<\/option><option  value=\"Lithuania\" data-code=\"LT\">Lithuania<\/option><option  value=\"Luxembourg\" data-code=\"LU\">Luxembourg<\/option><option  value=\"Macao\" data-code=\"MO\">Macao<\/option><option  value=\"Macedonia\" data-code=\"MK\">Macedonia<\/option><option  value=\"Madagascar\" data-code=\"MG\">Madagascar<\/option><option  value=\"Malawi\" data-code=\"MW\">Malawi<\/option><option  value=\"Malaysia\" data-code=\"MY\">Malaysia<\/option><option  value=\"Maldives\" data-code=\"MV\">Maldives<\/option><option  value=\"Mali\" data-code=\"ML\">Mali<\/option><option  value=\"Malta\" data-code=\"MT\">Malta<\/option><option  value=\"Marshall Islands\" data-code=\"MH\">Marshall Islands<\/option><option  value=\"Martinique\" data-code=\"MQ\">Martinique<\/option><option  value=\"Mauritania\" data-code=\"MR\">Mauritania<\/option><option  value=\"Mauritius\" data-code=\"MU\">Mauritius<\/option><option  value=\"Mayotte\" data-code=\"YT\">Mayotte<\/option><option  value=\"Mexico\" data-code=\"MX\">Mexico<\/option><option  value=\"Micronesia\" data-code=\"FM\">Micronesia<\/option><option  value=\"Moldova\" data-code=\"MD\">Moldova<\/option><option  value=\"Monaco\" data-code=\"MC\">Monaco<\/option><option  value=\"Mongolia\" data-code=\"MN\">Mongolia<\/option><option  value=\"Montenegro\" data-code=\"ME\">Montenegro<\/option><option  value=\"Montserrat\" data-code=\"MS\">Montserrat<\/option><option  value=\"Morocco\" data-code=\"MA\">Morocco<\/option><option  value=\"Mozambique\" data-code=\"MZ\">Mozambique<\/option><option  value=\"Myanmar\" data-code=\"MM\">Myanmar<\/option><option  value=\"Namibia\" data-code=\"NA\">Namibia<\/option><option  value=\"Nauru\" data-code=\"NR\">Nauru<\/option><option  value=\"Nepal\" data-code=\"NP\">Nepal<\/option><option  value=\"Netherlands\" data-code=\"NL\">Netherlands<\/option><option  value=\"New Caledonia\" data-code=\"NC\">New Caledonia<\/option><option  value=\"New Zealand\" data-code=\"NZ\">New Zealand<\/option><option  value=\"Nicaragua\" data-code=\"NI\">Nicaragua<\/option><option  value=\"Niger\" data-code=\"NE\">Niger<\/option><option  value=\"Nigeria\" data-code=\"NG\">Nigeria<\/option><option  value=\"Niue\" data-code=\"NU\">Niue<\/option><option  value=\"Norfolk Island\" data-code=\"NF\">Norfolk Island<\/option><option  value=\"North Korea\" data-code=\"KP\">North Korea<\/option><option  value=\"Northern Mariana Islands\" data-code=\"MP\">Northern Mariana Islands<\/option><option  value=\"Norway\" data-code=\"NO\">Norway<\/option><option  value=\"Oman\" data-code=\"OM\">Oman<\/option><option  value=\"Pakistan\" data-code=\"PK\">Pakistan<\/option><option  value=\"Palau\" data-code=\"PW\">Palau<\/option><option  value=\"Palestine\">Palestine<\/option><option  value=\"Panama\" data-code=\"PA\">Panama<\/option><option  value=\"Papua New Guinea\" data-code=\"PG\">Papua New Guinea<\/option><option  value=\"Paraguay\" data-code=\"PY\">Paraguay<\/option><option  value=\"Peru\" data-code=\"PE\">Peru<\/option><option  value=\"Philippines\" data-code=\"PH\">Philippines<\/option><option  value=\"Pitcairn\" data-code=\"PN\">Pitcairn<\/option><option  value=\"Poland\" data-code=\"PL\">Poland<\/option><option  value=\"Portugal\" data-code=\"PT\">Portugal<\/option><option  value=\"Puerto Rico\" data-code=\"PR\">Puerto Rico<\/option><option  value=\"Qatar\" data-code=\"QA\">Qatar<\/option><option  value=\"Reunion\" data-code=\"RE\">Reunion<\/option><option  value=\"Romania\" data-code=\"RO\">Romania<\/option><option  value=\"Russia\" data-code=\"RU\">Russia<\/option><option  value=\"Rwanda\" data-code=\"RW\">Rwanda<\/option><option  value=\"Saint Barthelemy\" data-code=\"BL\">Saint Barthelemy<\/option><option  value=\"Saint Helena, Ascension and Tristan da Cunha\">Saint Helena, Ascension and Tristan da Cunha<\/option><option  value=\"Saint Kitts and Nevis\" data-code=\"KN\">Saint Kitts and Nevis<\/option><option  value=\"Saint Lucia\" data-code=\"LC\">Saint Lucia<\/option><option  value=\"Saint Martin (French part)\">Saint Martin (French part)<\/option><option  value=\"Saint Pierre and Miquelon\" data-code=\"PM\">Saint Pierre and Miquelon<\/option><option  value=\"Saint Vincent and the Grenadines\" data-code=\"VC\">Saint Vincent and the Grenadines<\/option><option  value=\"Samoa\" data-code=\"WS\">Samoa<\/option><option  value=\"San Marino\" data-code=\"SM\">San Marino<\/option><option  value=\"Sao Tome and Principe\" data-code=\"ST\">Sao Tome and Principe<\/option><option  value=\"Saudi Arabia\" data-code=\"SA\">Saudi Arabia<\/option><option  value=\"Senegal\" data-code=\"SN\">Senegal<\/option><option  value=\"Serbia\" data-code=\"RS\">Serbia<\/option><option  value=\"Seychelles\" data-code=\"SC\">Seychelles<\/option><option  value=\"Sierra Leone\" data-code=\"SL\">Sierra Leone<\/option><option  value=\"Singapore\" data-code=\"SG\">Singapore<\/option><option  value=\"Sint Maarten (Dutch part)\">Sint Maarten (Dutch part)<\/option><option  value=\"Slovakia\" data-code=\"SK\">Slovakia<\/option><option  value=\"Slovenia\" data-code=\"SI\">Slovenia<\/option><option  value=\"Solomon Islands\" data-code=\"SB\">Solomon Islands<\/option><option  value=\"Somalia\" data-code=\"SO\">Somalia<\/option><option  value=\"South Africa\" data-code=\"ZA\">South Africa<\/option><option  value=\"South Georgia and the South Sandwich Islands\" data-code=\"GS\">South Georgia and the South Sandwich Islands<\/option><option  value=\"South Korea\" data-code=\"KR\">South Korea<\/option><option  value=\"South Sudan\" data-code=\"SS\">South Sudan<\/option><option  value=\"Spain\" data-code=\"ES\">Spain<\/option><option  value=\"Sri Lanka\" data-code=\"LK\">Sri Lanka<\/option><option  value=\"Sudan\" data-code=\"SD\">Sudan<\/option><option  value=\"Suriname\" data-code=\"SR\">Suriname<\/option><option  value=\"Svalbard and Jan Mayen\" data-code=\"SJ\">Svalbard and Jan Mayen<\/option><option  value=\"Swaziland\" data-code=\"SZ\">Swaziland<\/option><option  value=\"Sweden\" data-code=\"SE\">Sweden<\/option><option  value=\"Switzerland\" data-code=\"CH\">Switzerland<\/option><option  value=\"Syria\" data-code=\"SY\">Syria<\/option><option  value=\"Taiwan\" data-code=\"TW\">Taiwan<\/option><option  value=\"Tajikistan\" data-code=\"TJ\">Tajikistan<\/option><option  value=\"Tanzania\" data-code=\"TZ\">Tanzania<\/option><option  value=\"Thailand\" data-code=\"TH\">Thailand<\/option><option  value=\"Timor-Leste\">Timor-Leste<\/option><option  value=\"Togo\" data-code=\"TG\">Togo<\/option><option  value=\"Tokelau\" data-code=\"TK\">Tokelau<\/option><option  value=\"Tonga\" data-code=\"TO\">Tonga<\/option><option  value=\"Trinidad and Tobago\" data-code=\"TT\">Trinidad and Tobago<\/option><option  value=\"Tunisia\" data-code=\"TN\">Tunisia<\/option><option  value=\"Turkey\" data-code=\"TR\">Turkey<\/option><option  value=\"Turkmenistan\" data-code=\"TM\">Turkmenistan<\/option><option  value=\"Turks and Caicos Islands\" data-code=\"TC\">Turks and Caicos Islands<\/option><option  value=\"Tuvalu\" data-code=\"TV\">Tuvalu<\/option><option  value=\"Uganda\" data-code=\"UG\">Uganda<\/option><option  value=\"Ukraine\" data-code=\"UA\">Ukraine<\/option><option  value=\"United Arab Emirates\" data-code=\"AE\">United Arab Emirates<\/option><option  value=\"United Kingdom\" data-code=\"GB\">United Kingdom<\/option><option  value=\"United States\" data-code=\"US\">United States<\/option><option  value=\"United States Minor Outlying Islands\" data-code=\"UM\">United States Minor Outlying Islands<\/option><option  value=\"Uruguay\" data-code=\"UY\">Uruguay<\/option><option  value=\"Uzbekistan\" data-code=\"UZ\">Uzbekistan<\/option><option  value=\"Vanuatu\" data-code=\"VU\">Vanuatu<\/option><option  value=\"Vatican City\">Vatican City<\/option><option  value=\"Venezuela\" data-code=\"VE\">Venezuela<\/option><option  value=\"Vietnam\" data-code=\"VN\">Vietnam<\/option><option  value=\"Virgin Islands, British\">Virgin Islands, British<\/option><option  value=\"Virgin Islands, U.S.\">Virgin Islands, U.S.<\/option><option  value=\"Wallis and Futuna\" data-code=\"WF\">Wallis and Futuna<\/option><option  value=\"Western Sahara\" data-code=\"EH\">Western Sahara<\/option><option  value=\"Yemen\" data-code=\"YE\">Yemen<\/option><option  value=\"Zambia\" data-code=\"ZM\">Zambia<\/option><option  value=\"Zimbabwe\" data-code=\"ZW\">Zimbabwe<\/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 is invalid\"   \/> 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 is invalid\"   \/> 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) is invalid\"   \/> 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) is invalid\"   \/> 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) is invalid\"   \/> 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) is invalid\"   \/> 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) is invalid\"   \/> 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) is invalid\"   \/> 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) is invalid\"   \/> 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) is invalid\"   \/> 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) is invalid\"   \/> 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; is invalid\"   \/> 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; is invalid\"   \/> 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; is invalid\"   \/> 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; is invalid\"   \/> 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; is invalid\"   \/> 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; is invalid\"   \/> 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; is invalid\"   \/> 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; is invalid\"   \/> 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; is invalid\"   \/> 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; is invalid\"   \/> 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; is invalid\"   \/> 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; is invalid\"   \/> 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; is invalid\"   \/> 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; is invalid\"   \/> 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; is invalid\"   \/> 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 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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_ugg2k\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_ugg2k\" 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\/ 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