Intake Form Submission

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We have reached the submission limit for today. New appointment requests will be available tomorrow.
Intake Form Submission
Throughout this intake form we will ask you a series of question to help assess your needs and refer you to our services and appointments at The Refugee Centre.

Please complete the four main sections:
1. Section 1: Contact & General Information
2. Section 2: Services at The Refugee Centre
3. Section 3: Questionnaire
4. Section 4: First Intake Appointment & Caseworker
Once you submit your intake form, your assigned case worker will be reaching out to you via phone and/or email in the next 3-4 days to follow-up, book your first intake appointment, and help you book all your needed services at The Refugee Centre.

Section 1: Contact & General Information
Full Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Sex:*

FemaleMaleOtherPrefer not to say
Email Address*
example@example.com
Phone Number*
Please enter a valid Canadian phone number we can reach out to you on.
Marital Status:*
If you chose "other" for Marital Status, please indicate:
Do you have any family members with you in Canada?*
Number of Children (if applicable)
Where are you contacting us from?*

Montreal, CanadaOttawa, CanadaToronto, CanadaInternationalOther
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
When did you first enter Canada?*

DayMonthYear
Date
Country of Origin*
Previous Country of Residence:*
Legal Status in Canada:*

Asylum Seeker/Refugee ClaimantAccepted Refugee/Convention RefugeePermanent ResidencyCanadian CitizenUndocumented RefugeeInternational StudentOther
What languages do you speak?*

EnglishFrenchSpanishArabicPersianHindiTurkishOther
Do you need a interpreter for your appointments?*

YesNo

Section 2: Services at The Refugee Centre

We offer the following services at The Refugee Centre

Legal Aid Services - We offer legal aid consultation appointments where we can support you through a range of services including refugee sponsorship, asylum claims, work/study permits, immigration, HNC, and much more.

Orientation Appointment - We offer one on one orientation to help create a guide specific to their social needs. Once we are able to establish their priorities, we can then direct them to services we provide, or organizations within the Montreal community.

Academic Aid Appointment - We offer one-to-one appointments to help assist and guide you in your education and academic journey. We can also support you through academic equalization services, This services is offered to all ages, with the majority of work carried out by our interns and long-term academic counselors.

World Education Services (WES) - Gateway Program - The WES Gateway Program assesses the educational credentials of individuals who have limited proof of their academic achievements due to adverse circumstances. Individuals educated in a number of countries are eligible for the program.

Language Classes - We offer IELTS training, English, and French classes, and one-on-one tutoring. This is offered to students of all ages!

Work Permits or Study Permits - We can support you with your work and study permits. This service is available for asylum seekers and refugees only.

Healthcare Support Appointment - During our one-on-one healthcare support individuals can address their health needs and concerns. During this appointment we can also help you find community resources and health referrals.

Wellness Support Appointment - In the individual wellness support, individual can discuss general well-being, possible self-care and coping strategies. This appointment is a safe and confidential space to speak openly about your feelings, concerns, or challenges you are facing. We can support you by connecting you to further professional support if needed or wanted.

Employment Support Appointment - We offer individual appointments to support individuals with CV & Interview Preparation.

Financial Services and Entrepreneurship - During this appointment we can support you with basic needs such as how to open a bank account, Tax Clinics, to investments, and risk management, as well as entrepreneurship, including idea generation, and business planning. Our curriculum also emphasizes the importance of ethical decision-making, social responsibility, and sustainability in the finance and entrepreneurship industries.

Group Workshops & Activities - We offer a variety of group workshops and social activities including art workshops, cooking, exercise, yoga classes. Our activities are open to a range of ages!

Please select the type of support and services you are looking for below. During your First Intake Appointment at The Refugee Centre, your assigned case worker will help book your services based on your priorities and needs.
(Please select all that apply):*

Legal Aid Consultation (Asylum Claims. Work Permit, Study Permit)Orientation Support (Social Services)Academic AidEnglish Language ClassesFrench Language ClassesHealthcare SupportWellness SupportEmployment SupportFinancial Services and EntrepreneurshipWorld Education Services (WES) - Gateway ProgramGroup Workshops & Social ActivitiesOther
Have you ever received services from The Refugee Centre before?*

YesNo
Would you like to be added to our newsletter to receive updates about our services and events?*

YesNo

Section 3: Questionnaire

Please fill up the short questionnaire below. This questionnaire will help us learn more about your legal information and needs, and refer you to the right services at The Refugee Centre.
Reason for Seeking Refuge:*
Please indicate your Unique Client Identifier (UCI) number (if applicable):
The UCI number can be found on your Entry for Further Examination (Client ID Number), Acknowledgment of Claim, or on your Refugee Protection Claimant Document (RPCD).
Asylum Seeker/Refugee Claimant: What type of legal and identification document(s) do you currently have?*

Entry for Further Examination - (BSF536)Acknowledgement of Claim - (IM5985)Refugee Protection Claimant Document (Brown Paper) - (IM1442B)Notice of Decision from Court Hearing (Refused)Notice of Decision from Court Hearing (Accepted)Deportation DocumentWork PermitStudy PermitNoneOther
Accepted Refugee: What type of legal and identification document(s) do you currently have?*

Notice of Decision from Court Hearing (Accepted)Work PermitStudy PermitQuebec Selection Certificate (CSQ)Permanent Residency CardCanadian PassportNoneOther
Do you currently have a lawyer?*

YesNo
If applicable, what is your lawyer's name?
Asylum Seeker/Refugee Claimant: What are your Legal Needs? (please select all that apply)*

I need a Legal Aid ConsultationI want to make an Asylum ClaimI need to complete my IRCC Portal SubmissionI need to update my Change of AddressI need to submit my Basis of Claim (BOC)I need to apply for a Pre-Removal Risk AssessmentI want to appeal my Refugee Claimant DecisionI want to apply for a Study PermitI want to apply/renew my Work PermitI want to apply for a Travel DocumentNoneOther
Accepted Refugee: What are your Legal Needs? (please select all that apply)*

I need a Legal Aid ConsultationI want to apply/renew my Work PermitI want to apply for a Study PermitI want to submit my Certificat de sélection du Québec (CSQ) ApplicationI want to submit my Permanent Residency (PR) ApplicationI want to apply for a Travel DocumentI need to update my Change of AddressNoneOther
When is your admissibility interview (interview for further examination)? (if applicable)

DayMonthYear
Date
When was your Refugee Protection Claimant Document/Brown Paper (IM1442B) issued? (if applicable)

DayMonthYear
Date
When is your Court Hearing date? (if applicable)

DayMonthYear
Date
Are there any legal needs or information you would like us to know?
Do you need financial assistance (welfare assistance)?*

YesNo
Are you interested in the Refugee Sponsorship Program?
Would you be open to living in a different province?*

Section 4: First Intake Appointment & Case Worker

After you submit this form, you will be assigned to a caseworker at The Refugee Centre who will call you back to book your First Intake Appointment. Please share with us the days and times you are available on for a call back. During your First Intake Appointment, your assigned case worker will also be able to refer and book your needed appointments, and follow-up with you as you navigate our services.
Your assigned case worker will reach out to you throughout the week to book your First Intake Appointment. Choose which days you are available on:*

MondayTuesdayWednesdayThursdayFriday
What times are you available on?*

Morning (8:00 am - 10:00 am)Afternoon (1:30 pm - 4:00 pm)Morning (10:00 am - 12:30 pm)Afternoon (4:00 pm - 6:00 pm)
I prefer to have my First Intake Appointment held:*

Over the PhoneOnline
Phone Number
Please enter a valid Canadian phone number we can reach out to you on.
Would you like to provide us any additional information?
How did you hear about us?*

FriendGoogleSocial MediaOther OrganizationsGovernmentOther
I give my consent for The Refugee Centre to hold my personal information:*

Please check this box to provide us your consent to save your information.
Should be Empty:

We have reached the submission limit for today. New appointment requests will be available tomorrow.

Intake Form Submission

Section 1: Contact & General Information

Section 2: Services at The Refugee Centre

Section 3: Questionnaire

Section 4: First Intake Appointment & Case Worker