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En Route Registration Form

Chương trình Achieve

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 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.  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.  Meeting these minimum criteria does not guarantee services or immediate services.

Referring Agency Information

Information of intended service recipients:

Address
Address
City
State/Province
Zip/Postal
Country
Preferred Official Language

No. of Family Members:

Immigration Status (Choose one)

Indicate the issues/barriers to settlement the individual/family is facing by checking all appropriate boxes:

Barriers to Settle in the Community
Hardships/Difficulties
Complex Life Situation
Consent to Release Information:  By signing below you, the referred individual, 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.  If you are referring yourself, your signature indicates your voluntary consent to release this information for the same purpose.  This release will be in effect for two years from the date of signature.

Questions? Feel free to email,

Liza Ferris at  [email protected]

Client Confidentiality:  Kamloops Immigrant Services protects personal information by following the government’s 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

KIS En Route program
448 Tranquille Road, Kamloops BC V2B 3H2

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