Phone Number (include area code - 506- xxx-xxxx) *
Your answer
First Name *
Your answer
Last Name *
Your answer
Home Address (with Postal Code) *
Your answer
Date of Birth (mm/dd/yy) *
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What is your country of origin (nationality as shown on international passport)? *
Your answer
Which of these best describes your immigration status? *
If you are a Permanent Resident (PR), please write down your PR number in the field below.
*
Your answer
During the program, which of the following topics would you be interested in?
*
Required
Are you interested in mentorship? *
If yes, what mentorship field are you interested in? (e.g. Academic/Emotional/Career)
Your answer
This program will take place for 8 weeks, every Saturday, from 10 am to 1 pm. Does this time work for you? *
What is your preferred communication way during the program? *
How did you first learn about the YALI Program? *
Required
If you initially discovered the YALI program through social media, kindly specify the social media platform through which you learned about it.
Consent to be photographed (during classes, workshops and special events for PRUDE Social Media) *
Consent to be contacted by IRCC (Immigration, Refugee and Citizenship Canada may contact you for a survey) *
Thank you for completing this registration form. Please do not hesitate to reach out via email at
ogorchukwu@prudeinc.org or visit the websiteif you have any questions or concerns.
If there is any information you would like to share please leave it in the section below.
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