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Pre Assessment Form

First Name *

Last Name *

Street Address *

City *

Country *

Province/State *

Nationality *

Contact Number with Country Code *

Date of Birth (DD/MM/YYYY) *

Email Address *

Gender *

Male
Female

Current Highest Qualification *

Total number of study years after Intermediate *

Year of Completion (MM/DD/YYYY) *

Subjects studied / Specialization *

Your area of interest for studies in Canada (Any 3)

Work Experience in Years

Field of Experience

Blood Relatives in Canada *

Yes
No

If Yes please name the blood relation

IELTS Score ( If any) *

Academic
General

Listening (Band)

Speaking (Band)

Reading (Band)

Writing (Band)

Overall (Band)

Marital Status *

Yes
No

IF MARRIED, PLEASE COMPLETE BELOW

Name of Spouse

Contact Number of Spouse with Country Code

Date of Birth of Spouse

Nationality of Spouse

Email Address of Spouse

Gender of Spouse

Male
Female

Complete Address (Same as above or enter below)

Current Highest Qualification of Spouse

Work Experience in Years

Year of Completion

Field of Experience

IELTS Score ( If any)

Academic
General

Listening (Band)

Speaking (Band)

Reading (Band)

Writing (Band)

Overall (Band)

Comment

Please note that all information provided will be kept in strict confidence and used for educational purposes.

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