Refugee Class Assessment

Please complete the following form and send it to us.

Your full name
Nationality
Where do you live now?
Age
Marital Status
Number of children, their ages
Phone number
E-mail address
Are you able to come to Canada?
Please tell us how you have been harmed or threatened, when it happened, why, who did this, how often, and give any details that would be helpful to us
How did you hear of us?
 
Confirm e-mail address

Please review your details prior to submission.