Permanent Resident (Maple Leaf) Card 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

Any travel plans going outside of Canada in the next 3 months? Yes No

Travel destination: Date (dd/mm/yy):

Have you been living in Canada at least 2 years in the last 5 years? Yes No

Additional information you would like to add:

How did you hear about Border Connections?