This form is private and confidential and will only be used by YWCA staff and our funder, Immigration, Refugees and Citizenship Canada (IRCC). It is designed to help us identify your settlement/employment needs. For more information please read the IRCC "Gathering Information" Document >>here<<.
 
Upon completion of this form we will be in touch with you, to confirm your registration and to obtain your immigration document number, over the phone.

Please contact us at 416-266-0303 if you have any questions or concerns.

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* 1. First Name:

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* 2. Last Name:

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* 3. Please provide your contact details below:

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* 4. What is your date of birth?

Date

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* 5. Gender:

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* 6. What is your current status in Canada?

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* 7. What country were you born in?

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* 8. Official Language of preference:

Please note that we are currently unable to provide services in French. However, we are happy to refer you to another agency. For more information or services in French, please visit the IRCC website at:
https://www.cic.gc.ca/francais/nouveaux/services/index.asp

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* 9. What other languages do you speak?

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* 10. How did you hear about the YWCA JUMP program?

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* 11. What best describes your current situation?

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* 12. What YWCA JUMP services/workshops or settlement supports are you interested in? (check all that apply)

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* 13. Privacy Statement:

The staff at YWCA JUMP program respect your privacy and the information that you share with us. We will use your personal information for registration purposes as well as to provide appropriate and effective services for you. All written information will only be seen by YWCA JUMP staff and our funder, Immigration, Refugees and Citizenship Canada (IRCC).

We will not share any of your personal information beyond the YWCA JUMP staff and our funder unless you agree and sign “Consent to Release Information”, or in some special situations.

You can ask to see your file and/or have a copy at any time.

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* 14. Consent Statement: (Click >>here<< to read this Consent Statement in multiple languages)

Immigration, Refugees and Citizenship Canada (IRCC) may want to contact you in the future. They will ask only about IRCC services, including services you receive from our organization, and if these services were useful to you and helped you settle in Canada. IRCC will use your answers, and answers from other immigrants, to improve services for all immigrants. This is voluntary: you are not obligated to answer IRCC’s questions. IRCC will not use your information to make any decisions about you personally.

Can IRCC, or an independent research company acting for IRCC, contact you in future?

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* 15. Do you consent to receiving informational emails from YWCA Toronto?

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* 16. Immigration Document Number/UCI # required to complete your registration (This includes your 8-10 digit numeric Client ID number on your Permanent Resident Card; or on your Record of Landing)

Thank you for completing the registration form!

 If you have any questions, you can reach us by email at jumpscarborough@ywcatoronto.org or by phone at 416-266-0303.

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