Velletta & Company - Immigration Assessment

Immigration Assessment Form

Fill out this questionnaire. Answer all the questions as best you can. If you don't know the answer to a question, just say so or type in 'd/k'. Send the completed questionnaire directly to us by following the simple instructions at the bottom of the form. We keep all information in strict confidence. When we have had a chance to review your Assessment, we will contact you to discuss how we can help.

Remember, no one can guarantee the confidentiality of information sent over the Internet. If you prefer, you may print this form, fill it in, then fax or mail the information to: Velletta & Company, 302-852 Fort St., Victoria, B.C. V8W 1H8. Telephone (250) 383-9104; Fax (250) 383-1922.

First Name:	Last Name:
Street Address:
City:	Country:
Home Phone:
E-mail:

Date of Birth:	Marital Status:	Number of Children:
Citizenship
All Countries of Residence for past 10 years
Where do you want to live in Canada?
Do you have relatives in Canada? Yes No
Do you or your family members have any medical problems? Yes No
Have you or your family members ever been convicted of a criminal offence? Yes No
Have you applied to immigrate to Canada before? Yes No
Have you or your spouse studied in Canada at a Post-Secondary Institution? Yes No
Have you or your spouse worked in Canada on a work permit? Yes No
Have you been to Canada before? Yes No

Describe your education (degrees obtained and total years of study):
What is your current occupation?		Employment length (Y-M)
What is your intended occupation in Canada?
What is your spouse's Education level?
Are you planning to start your own business in Canada? Yes No
English Ability
Read	Write	Speak
French Ability
Read	Write	Speak
Are you interested in information about the Immigrant Investor program? Yes No

Velletta & Company - Barristers, Solicitors and Notaries - Victoria BC Lawyers

Immigration Assessment Form

Section One: Who You Are And How We Can Reach You

Section Two: Personal Information

Section Three: Education, Occupation and Language Skills

English Ability

French Ability

Section Four: How To Submit Your Assessment Form

Internet Submission:

Fax or Postal System: