Information about the principal applicant

1- Identification: Principal Applicant

Family name: 
First name: 

Date of Birth:  DAY MONTH YEAR

Civil Status:  SINGLE MARRIED ENGAGED

Residence Address: 
NUMBER: STREET:
CITY: PROVINCE/STATE:
POSTAL CODE:
COUNTRY:
If your country is not listed, type it here

Mailing Address: 
NUMBER: STREET:
CITY: PROVINCE/STATE:
COUNTRY: POSTAL CODE:

Telephone:  HOME WORK OTHER

Fax:  HOME WORK OTHER

E-mail(1): 
E-mail(2): 


2- Education (Start with the most recent diploma)

Number of years Type of establishment Level of education Type of diploma Language of education
Public Private French English Other


3- Favoured Training (Start with the most recent one)

Post-secondary level

full-time studies

 University level


4- Work History

During the past ten years, including the job training periods as part of the curriculum of vocational of technical school apprenticeship, training programs, or specialized internships recognized by a diploma
Less than 6 months
 3 years
6 months 3 1/2 years
1 year 4 years
11/2 years 4 1/2 years
2 year 5 years
2 1/2 years  


5- Language Ability

Language None Beginner Intermediate Advanced
0
1 2 3 4
5 6 7 8
9 10 11 12
Oral French
Written French
Oral English
Written English


6- Trips to Quebec

Have you ever visited Quebec for work, study or any other reason?
Full-time studies for 1 academic session
Full-time studies for 2 or more academic sessions
Employment for st 3 months
Employment for st 6 months
Internship for st 3 months (bilateral agreement)
Internship for st 6 months (bilateral agreement)
A trip for other purposes for 2 to 3 months
A trip for other purposes for 3 months or more
No


7- Ties to Quebec

Do you or your spouse or common-law spouse have a relative or friend who is a Canadian citizen or landed immigrant living in Quebec?
Father, mother, brother, sister, son, daughter, husband, wife, common-law spouse
Grandfather, grandmother
Other relative
Friend
No


8- Children

Indicate how many children you have
With Children aged 12 and under :
With Children aged 17 and more:


9- Friends or relatives who want to immigrate

Family Name / First Name E-mail Telephone




Information about the spouse (If applicable)

10.1- Identification: Spouse

Family name: 
First name: 

Date of birth:  DAY MONTH YEAR


10.2- Education (Start with the recent diploma)

Number of years Type of establishment Level of education
Type of diploma		 Language of education
Public Private French English Other


10.3- Favoured Training (Start with the recent one)

Post-secondary level
Requiring 3 years of full-time studies		 University level


10.4- Work History

During the past ten years, including the job training periods as part of the curriculum of vocational of technical school apprenticeship, training programs, or specialized internships recognized by a diploma
Less than 6 months 3 years
6 months 3 1/2 years
1 year 4 years
11/2years 4 1/2 years
2 years 5 years
2 1/2years  


10.5- Language Ability

Language None Beginner Intermediate Advanced
0
1 2 3 4
5 6 7 8
9 10 11 12
Oral French
Written French
Oral English
Written English



10.6- Trips to Quebec

Have you ever visited Quebec for work, study or any other reason?
Full-time studies for 1 academic session
Full-time studies for 2 or more academic sessions
Employment for at least 3 months
Employment for at least 6 months
Internship for at least 3 months (bilateral agreement)
Internship for at least 6 months (bilateral agreement)
A trip for other purposes for 2 to 3 months
A trip for other purposes for 3 months or more
No


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