Request an Appointment Form

Pre Assessment Form

Please provide us with your information for your Study Pathway Assessment
We are excited that you have finally decided to take that step of visualizing your future with us. Thank you for spending your next 2 min in filling up these valuable Information necessary for your objective to STUDY-EARN-LIVE in Canada! Your data is secured, in compliance with Canada's Data Privacy Act. We shall get in touch with you shortly after this is submitted on line. From here on, be assured to experience Alagang iCanada, every step of the way.
Passport Name:*
(e.g. Juan Dela Cruz)
Client Information
Full Name of Applicant:*

First NameLast Name
Email*
example@example.com
Country Code:
Mobile Phone Number*
NA:

NA
Preferred Type of Consultation:*
Preferred consultation - Date/Time - 9:00AM-11:00PM*
Preferred consultation - Date/Time - 9:00AM-3:00PM*
Choose Consultation - Date/Time - 12:00 / 6:00-7:00PM*
Choose Consultation - Date/Time - 9:00AM-6:00PM*
Choose Consultation - Date/Time - 12:00PM / 7:00PM*
How did you hear about us?*

iCanada FB PageiCanada WebsiteiCanada WebinarFacebookReferralLinkedInTikTokInstagramEventsTim HortonsOthers: (Please specify)
Birthdate

YearMonthDay
Date
Age*
Age:
(Age between 17-65 yrs old only)
Date today*

MonthDayYear
Date
Hour MinutesAM/PM Option
Submission Date*

MonthDayYear
Date
Hour MinutesAM/PM Option
Current Location*

Full Address

Street Address 2

CityState / Province

Postal / Zip Code
Citizenship*
Highest Educational Attainment:*
Course/Program - Level:*
(e.g. BS Nursing - xxx Year)
School Graduated:*
School Name
Year Graduated:

YearMonthDay
Minimum graduated year not less than 1988.
Company:*
Years with last/current employer:*
Current Job:*
Choose Consultation - Date/Time - 9:00-5:00PM*
Preferred consultation date/time:*
Country Code
Phone Number
Country Code
Preferred Canada Province/School:*
What is your preferred Canada Province/School?
Target Program:*
Target Semester:*

Winter (January-April)Spring (May-August)Fall (September-December)Open to suggestion
Source/s of Funding for Application:*

FamilyRelatives, FriendsCorporate SponsorshipSavingsJobBusinessOther
Civil Status*

SingleMarriedWidowedDivorcedSeparatedOther
Who is part of the VISA Application:*

SoloSpouse or PartnerKids
Spouse or Partner Gender:*

MaleFemale
No. of Kids:*
Location of relatives/friends in Canada:*
Participation of indicated relatives/friends:*

AccommodationFinancialNoneOther

Kindly indicate your Official Tiktok Account:
(URL) - If no Tiktok account, Kindly indicate N/A.
Kindly indicate your Official Facebook Account:
(URL)
Kindly indicate your Official LinkedIn Account:
(URL) - If no LinkedIn account, Kindly indicate N/A.
Let us know any specific concerns:
Your Selected Consultation Date is:
iC Advisor
Social Media Source:
iC Advisor Name
iC Advisor Name:
iC Advisor Code:*
iC Advisor Email
Source/s of Funding for Studies (Values)
Participation of indicated relatives/friends (Values)
Kids/Dependents (Values)
Like & Follow Us:
Should be Empty:

	Account
Facebook
LinkedIn
Tiktok

Pre Assessment Form

Client Information