YOU CAN FILL OUT THIS FORM IF YOU WANT TO BE CONTACTED OR WANT MORE INFORMATION FROM DUTCH WESTERN CANADA CONNECTION.
Family name:
*
First name:
Address:
*
Postal code:
Place:
*
Country:
*
Nationality
*
Telephone number:
*
Mobile number:
E-mail address:
*
Age
18-25
26-35
36-45
45-55
55 and older
Marrial Status:
Single
Married
Divorced:
Widow(e)
Children:
Yes
No
Age of Children:
Wanted occupation in West Canada:
*
Years experience in wanted occupation:
*
Occupation Partner:
When do you want to immigrate?
1-6 months
6-12 months
1-2 years
2-3 years
more than 3 years
To which province do you want to immigrate?
Alberta
British Columbia
Saskatchewan
Yukon
NWT
Amount of money to start with in Canada:
less then $15,000
$15,001-$25,000
$25,001-35,000
more then $35,000
THE NEXT QUESTIONS WILL INDICATE US WHAT LEVEL OF KNOWLEDGE YOU HAVE ABOUT WESTERN CANADA
Have you ever been in Canada?
Yes
No
If you have been in Canada, where have you been?
Have not been in Canada
Alberta
British Columbia
Saskatchewan
NWT
Yukon
More then 1 of the Western Provinces
Other Province in Canada
How long have you been in Canada? Weeks/months/years?
THE FOLLOWING QUESTIONS WILL INDICATE YOUR LEVEL OF ENGLISH
Level of speaking:
poor
medium
good
excellent
Level of listening
poor
medium
good
excellent
Level of writing:
poor
medium
good
excellent
Level of reading:
poor
medium
good
excellent
Do you have any questions or remarks?
Would you like to be invited to one of our next information sessions?
Yes
No
I would like to get information by skype
If you wanted to be invited to one of our next information sessions, which location do you prefer?
Information Session by Skype
Doesn`t matter
This has to be filled out *