JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Newcomer Women's Leadership Program (NWLP) Registration Form (Intake)
Sign in to Google
to save your progress.
Learn more
* Indicates required question
First and Last/Family Name
*
Your answer
Birth Date: month/day/year
*
Your answer
What country are you from?
*
Your answer
Phone Number (include area code - 506- xxx-xxxx)
*
Your answer
Email Address
*
Your answer
Home Address
*
Your answer
Which of these best describes your immigration status?
*
A Permanent Resident (PR)
A Temporary Resident awaiting PR application approval
A Temporary Resident with work permit
A student with study permit
Canadian-Ukraine Authorization for Emergency Travel (CUAET)
Other:
Required
What is your Permanent Resident (PR) Card number? If applicable.
Type in 000-000 if you don't a PR card yet.
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number (include area code- e.g 506- xxx-xxxx)
*
Your answer
How did you hear of us?
*
Friend/Family
Other Settlement Organizations
Ethnic/cultural Group
Social Media
Other:
What are your expectations for this workshop?
*
Your answer
What is your preferred option for the leadership workshop?
*
Self-paced online lessons and in-person daily sessions with Rob Sancton about the Canadian Way Program at PRUDE Inc. from 10am to 12 noon
Self-paced online lessons, weekly peer discussions, and In-person community tours and Saturday hiking activities)
Other:
What is your preferred date and time for the weekly virtual group discussions?
*
Wednesday: 7pm - 8pm
Thursday: 7pm - 8pm
Friday: 7pm - 8pm
Why did you choose the time slot above as your preferred option?
*
Your answer
Consent to be photographed (during classes, workshops and special events for PRUDE Social Media)
*
Yes
No
Consent to be contacted by IRCC (Immigration, Refugee and Citizenship Canada may contact you for a survey)
*
Yes
No
You will be contacted by email or phone for a needs assessment to evaluate if the program is the best fit for you at this time. What is the best way to contact you? Please ensure we have the right contact information on this form.
*
Phone
Email
Thank you for completing this registration form. Please do not hesitate to reach out via email at
christine@prudeinc.org
if you have any questions or concerns. If there is any information you would like to share, please leave it in the section below.
*
Your answer
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This form was created inside of PRUDE Inc..
Report Abuse
Forms
