Canadian Citizenship Free Assessment

First Name:

Last Name:

E-mail:

Telephone:

Street:

City:

State/Province:

Zip/Postal Code:

Country:

Nationality:

Age:

Are you a permanent resident (landed immigrant) of Canada? Yes No

When did you become a permanent resident (month/year)?

Are you a Canadian citizen? Yes No

Are you currently living in Canada? Yes No

Have you been living in Canada at least 3 years in the last 4 years? Yes No

Are you under a removal order? Yes No

Are you now charged with an indictable criminal offence? Yes No

Have you been convicted of an indictable criminal offence in the past 3 years?
Yes No

Have you been in prison, on parole, or on probation in the past 4 years? Yes No

Are you being investigated or convicted of war crimes? Yes No

Have you had your citizenship revoked in the last five years? Yes No

Additional information you would like to add:

How did you hear about Border Connections?