Kamloops Immigrant Services

Client Intake Form

Please fill out the information below. If you need assistance, let us know.

Personal Information

First Name *

Last Name *

Address

City *

Postal Code *

Phone *

Email *

Date of Birth *

Gender *

Language and Background

Official Language *

Mother Tongue *

Country of Birth *

Current Occupation

Immigration Information

Immigration Status *

Immigration Class

Unique Client Identifier (UCI) i

Date of Arrival in Canada

Reason for Seeking Services

Type of help needed

Family Members

Add Family Member

Add any family members included with this intake.

Family Member

First Name *

Last Name *

Unique Client Identifier (UCI)

Date of Birth *

Email *

Phone *

Relation *

Gender *

Country of Birth *

How did you hear about us?

Please select one option

Confidentiality Statement

Kamloops Immigrant Services protects personal information by following the government’s privacy laws as outlined in the Personal Information Protection Act, Bill 38. Personal Information provided to Kamloops-Cariboo Regional Immigrants Society (KCRIS) is used to meet client’s needs, statistics, evaluation of service and research by the federal/provincial government. Staff will not disclose any information without client permission unless legally obligated to do so. Completion and submission of this intake form implies consent to collecting information for these purposes.

I certify that all of the information provided herein is true and complete to the best of my knowledge. I understand that any misstatement, falsification or omission is grounds for termination of service.

Consent for Future Immigration, Refugees and Citizenship Canada Research / Consultation

Consent to be added to Kamloops Immigrant Services' mailing list for events and workshops

Client Signature *

Fields marked with * are required.

Submit Form

It looks like you are already registered with KIS.

Existing Client Short Form