Indian Boarding Homes

Indian Boarding Homes - Intake Form

Canada created the Indian Boarding Homes Program in the 1950s which removed First Nations, Inuit, and sometimes Métis children from their communities and placed them in private homes for the purpose of attending public school. Please include only private home placements. PLEASE KNOW: Group homes, dorms and hostels are NOT covered under this class action
Name

First NameLast Name
Have you already filed Category 1?

YesNoI don't know
If yes, have you been approved and received the $10,000 payment?

YesNoI don't know
Were you referred by someone?

YesNo
If yes, who referred you?
Birthday*

MonthDayYear
Date
Please include your contact information, or we will NOT be able to contact you.
Email*
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityProvince

Postal
Which one do you identify as?

First NationsMétisInuit
If applicable, what Nation are you from?
If different from above, what Community were you removed from?
Would you consider your home community as remote?

YesNo
Why were in you placed in the Indian Boarding Homes Program?*
If Other, explain:
Did you return home to your reserve or community for summer and christmas (school breaks)

YesNoI don't remember
If no, explain why:
Indian Boarding Homes Attended:

Please know that any foster homes, group homes, dorms, hostels, residential schools, and boarding schools are NOT a part of this class action. Please do NOT include them.
NOTE: If you have stayed in more than FOUR (4) boarding homes, please include the ones where you experienced the most abuse.
Boarding Home #1
Who did you stay with? If you don't remember, that's okay
Name of the host family
Was the host family related to you?

YesNoI don't know
Where was the boarding house located
City and Province
When were you at this house? (years or ages)
What grade(s) did you attend?
What school did you attend while you were there?
How many boarders were in the home with you?
Did you experience abuse in this home?

NoYesI don't know
If yes, what kind of abuse did you experience?

Emotional AbusePhysical AbuseSexual AbuseNeglectOther
If you are able to give us more details about your expereince, please do. (All details will be kept between you and the law firm)
Boarding Home #2
Who did you stay with? If you don't remember, that's okay
Name of the host family
Was the host family related to you?

YesNoI don't know
Where was the boarding house located
City and Province
When were you at this house? (years or ages)
What grade(s) did you attend?
What school did you attend while you were there?
How many boarders were in the home with you?
Did you experience abuse in this home?

NoYesI don't know
If yes, what kind of abuse did you experience?

Emotional AbusePhysical AbuseSexual AbuseNeglectOther
If you are able to give us more details aabout your expereince, please do. (All details will be kept between you and the law firm)
Boarding Home #3
Who did you stay with? If you don't remember, that's okay
Name of the host family
Was the host family related to you?

YesNoI don't know
Where was the boarding house located?
City, Province
When were you at this house? (years or ages)
What grade(s) did you attend?
What school did you attend while you were there?
How many boarders were in the home with you?
Did you experience abuse in this home?

NoYesI don't know
If yes, what kind of abuse did you experience?

Emotional AbusePhysical AbuseSexual AbuseNeglectOther
If you are able to give us more details aabout your expereince, please do. (All details will be kept between you and the law firm)
Boarding Home #4
Who did you stay with? If you don't remember, that's okay
Name of the host family
Was the host family related to you?

YesNoI don't know
Where was the boarding house located?
City, Province
When were you at this house? (years or ages)
What grades did you attend?
What school did you attend while you were there?
How many boarders were in the home with you?
Did you experience abuse in this home?

NoYesI don't know
If yes, what kind of abuse did you experience?

Emotional AbusePhysical AbuseSexual AbuseNeglectOther
If you are able to give us more details aabout your expereince, please do. (All details will be kept between you and the law firm)
Should be Empty:

Indian Boarding Homes - Intake Form

Indian Boarding Homes Attended:

Boarding Home #1

Boarding Home #2

Boarding Home #3

Boarding Home #4