CVIMS Client Intake Form Client Intake Request FormYour Personal DetailsFirst Name(Required)Middle NameLast Name(Required)Preferred/Other NameDate of Birth(Required) Marital Status(Required)Common-LawDivorcedMarriedSeparatedSingleWidowedUnknownSex at Birth(Required)FemaleMaleUnknownxPronounsHe/HimShe/HerThey/ThemOtherEmail Address(Required) Phone Number(Required)Secondary PhoneLevel of EducationHigh School or LowerPre-university/Post SecondaryCertificate/Diploma/ApprenticeshipBachelor DegreeMaster DegreePh.D.OtherNative Language(Required)EnglishFrenchAfrikaansAlbanianAmharicArabicArmenianBengaliBisayaBurmeseCantoneseCatalanCebuanoChineseChinese - SimplifiedChinese - TraditionalCreoleCroatianCzechDanishDutchFarsi (Persian)FilipinoGermanGujaratiHiligaynonHindiHungarianIlicanIlocanoIndonesianItalianItsekiriJapaneseKarenKinyarwandaKoreanMalagasyMalayalamMandarinMarathiMizoNepaliOther Middle Eastern LanguagesPashtoPolishPortuguesePunjabiRomanianRussianSerbianShonaSinhaleseSloveneSomaliSpanishSwahiliTagalogTamilTeluguThaiTigrignaTurkishUkrainianUrduVietnameseYorubaAcholiAdaAffarAfghanAkaAkanAklanonAkraAmerican Sign Language (ASL)Anuak (Anywa)AranAshantiAssameseAssyrianAzeriBahasa IndonesianBalochiBambaraBamileke / GhomalaBansoBantuBauleBelarusianBelenBembaBembeBeniBeninBerberBetiBhariBicol/Bikol/BicolanoBijaiyaBilenBiniBissaBontokBraille (translation only)BretonBulgarianBurji / Bembala / Bambala / DaashiBusanBusangoChakmaChaldeanChaochoChavacanoChichewaChinChiuchowChiyaoChowchauConcaniCreeDagaareDariDaza / Dazaga / TebuDinkaDioulaDzongkhaEdoEfikEsanEstonianEweFangFantiFe'fe / Fe'efe'e / Nufi / BafangFinnishFlemishFoochowFoukiFoullahFukineseFulaniGaGaelicGeorgianGrebo/KrumenGreekGuerzeHainamHakha ChinHakkaHararaHararyHargarHassanyaHausaHebrewHindkoHokkinIbibioIboIcelandicIdomaIgboIgorotIjawIkaIlongoIshanIvbiosakonIziJaraiJavaneseJingpoJolayJuba ArabicKacchiKakwaKanareseKandahariKankaniKannadaKapampanganKashmiriKazakhKenyang / Nyang / Banyang / ManyangKhmerKifuliruKihavuKihemba/Hemba/Kiluba-HembaKikambaKikongoKinnauriKinyamulengeKiregaKirundiKiswahiliKitubaKonkaniKpelleKrioKurdishKurmanjiKyrgyzLa langue des signes québécoise (LSQ)LaotianLariLatvianLebaneseLengieLingalaLithuanianLowmaLugandaLugishuLutoroMabanMacedonianMacenaMacuaMahouMakondeMalayMaligoMalinkeMalteseMandeMandingoMasalitMashiMendeMinaMoldovanMongolianMooreNaandi/CemualNdebeleNgiemboonNgombaNorwegianNubianNuerNzimaOkoOkpeOriyaOromoOsalOther African LanguagesOther Chinese DialectsOther European LanguagesOther LanguagesOther Signed LanguagesOther South Asian LanguagesOther South East Asian Lang.OtuhoPahariPampangoPangasinanPeulPhuockienPidginPlautdietschPoularRohingyaRomaniRukigaRunyankoleRutooroSahoSamoanSangoSanskritSaraScoulaSechuanSenufoSerbo-CroatianSesothoSeswiSeychellesShanShanghaiShansaiShillukSign LanguageSindhiSlovakSonghaiSoninkeSoraniSothoSoussouSouthern BurunSuesueSukumaSwazaiSwedishSwiss GermanTaichewTamasheqTariTatarTatshaneseTemneTeochewTibetanTichiewTigreTiminiTivToishanTshilubaTsibulaTwiUdukUhroboUigrigmaUmbunduUnamaUnknownUyghurUzbekVisayanWarayWelshWestern Hemisphere Indian LangWolofXhosaYacoubaYako/Loko/LokaaYekhee/Afenmai/AfemaiYiboeYiddishZandeZshilubaZugandaZuluOther Spoken Languages (if applicable)EnglishFrenchAfrikaansAlbanianAmharicArabicArmenianBengaliBisayaBurmeseCantoneseCatalanCebuanoChineseChinese - SimplifiedChinese - TraditionalCreoleCroatianCzechDanishDutchFarsi (Persian)FilipinoGermanGujaratiHiligaynonHindiHungarianIlicanIlocanoIndonesianItalianItsekiriJapaneseKarenKinyarwandaKoreanMalagasyMalayalamMandarinMarathiMizoNepaliOther Middle Eastern LanguagesPashtoPolishPortuguesePunjabiRomanianRussianSerbianShonaSinhaleseSloveneSomaliSpanishSwahiliTagalogTamilTeluguThaiTigrignaTurkishUkrainianUrduVietnameseYorubaAcholiAdaAffarAfghanAkaAkanAklanonAkraAmerican Sign Language (ASL)Anuak (Anywa)AranAshantiAssameseAssyrianAzeriBahasa IndonesianBalochiBambaraBamileke / GhomalaBansoBantuBauleBelarusianBelenBembaBembeBeniBeninBerberBetiBhariBicol/Bikol/BicolanoBijaiyaBilenBiniBissaBontokBraille (translation only)BretonBulgarianBurji / Bembala / Bambala / DaashiBusanBusangoChakmaChaldeanChaochoChavacanoChichewaChinChiuchowChiyaoChowchauConcaniCreeDagaareDariDaza / Dazaga / TebuDinkaDioulaDzongkhaEdoEfikEsanEstonianEweFangFantiFe'fe / Fe'efe'e / Nufi / BafangFinnishFlemishFoochowFoukiFoullahFukineseFulaniGaGaelicGeorgianGrebo/KrumenGreekGuerzeHainamHakha ChinHakkaHararaHararyHargarHassanyaHausaHebrewHindkoHokkinIbibioIboIcelandicIdomaIgboIgorotIjawIkaIlongoIshanIvbiosakonIziJaraiJavaneseJingpoJolayJuba ArabicKacchiKakwaKanareseKandahariKankaniKannadaKapampanganKashmiriKazakhKenyang / Nyang / Banyang / ManyangKhmerKifuliruKihavuKihemba/Hemba/Kiluba-HembaKikambaKikongoKinnauriKinyamulengeKiregaKirundiKiswahiliKitubaKonkaniKpelleKrioKurdishKurmanjiKyrgyzLa langue des signes québécoise (LSQ)LaotianLariLatvianLebaneseLengieLingalaLithuanianLowmaLugandaLugishuLutoroMabanMacedonianMacenaMacuaMahouMakondeMalayMaligoMalinkeMalteseMandeMandingoMasalitMashiMendeMinaMoldovanMongolianMooreNaandi/CemualNdebeleNgiemboonNgombaNorwegianNubianNuerNzimaOkoOkpeOriyaOromoOsalOther African LanguagesOther Chinese DialectsOther European LanguagesOther LanguagesOther Signed LanguagesOther South Asian LanguagesOther South East Asian Lang.OtuhoPahariPampangoPangasinanPeulPhuockienPidginPlautdietschPoularRohingyaRomaniRukigaRunyankoleRutooroSahoSamoanSangoSanskritSaraScoulaSechuanSenufoSerbo-CroatianSesothoSeswiSeychellesShanShanghaiShansaiShillukSign LanguageSindhiSlovakSonghaiSoninkeSoraniSothoSoussouSouthern BurunSuesueSukumaSwazaiSwedishSwiss GermanTaichewTamasheqTariTatarTatshaneseTemneTeochewTibetanTichiewTigreTiminiTivToishanTshilubaTsibulaTwiUdukUhroboUigrigmaUmbunduUnamaUnknownUyghurUzbekVisayanWarayWelshWestern Hemisphere Indian LangWolofXhosaYacoubaYako/Loko/LokaaYekhee/Afenmai/AfemaiYiboeYiddishZandeZshilubaZugandaZuluCurrent Residential AddressAddress(Required)Apt/Unit #City(Required)NanaimoDuncanLadysmithParksvillePort Alberni100 Mile House108 Mile House108 Mile Ranch150 Mile HouseAbbotsfordAgassizAhousatAldergroveAlert BayAlexis CreekAlkali LakeArmstrong,British ColumbiaAshcroftAtlinAvolaBalfourBamfieldBarriereBeach GroveBear LakeBeaver CoveBeaverdellBella BellaBella CoolaBlack CreekBlack PointBlue RiverBob Quinn LakeBoston BarBoswellBowen IslandBowserBridge LakeBritannia BeachBurnabyBurns LakeCache CreekCampbell RiverCanal FlatsCassiarCastlegarCelistaChaseChemainusChetwyndChilliwackChristina LakeClearwaterClinton,British ColumbiaCobble HillColdstreamColwoodComoxCoquitlamCourtenayCowichan BayCranbrookCrawford BayCrescent BeachCrestonCumberland,British ColumbiaD`ArcyDawson CreekDease LakeDelta,British ColumbiaDonaldDouglas LakeDunsterEast PineElkfordElkoEnderbyEstevan PointFairmont Hot SpringsFalklandFauquier,British ColumbiaFernieField,British ColumbiaFlatrock, British ColumbiaForest GroveFort FraserFort NelsonFort St. JamesFort St. JohnFraser LakeFruitvaleGabriolaGaliano IslandGangesGibsonsGiscomeGold BridgeGold RiverGoldenGood Hope LakeGrand ForksGranisleGrasmereGrassy PlainsGreenvilleGreenwood,British ColumbiaHartley BayHazeltonHedleyHemlock ValleyHendrix LakeHixonHolbergHopeHorseflyHoustonHudson`s HopeInvermereIskutJaffrayKamloopsKasloKelownaKemanoKeremeosKimberleyKincolithKitimatKitkatlaKitsaultKitwangaKlemtuKyuquotLac la HacheLake CountryLake CowichanLangaraLangleyLantzvilleLikelyLillooetLittle FortLogan LakeLoosLower PostLumbyLyttonMackenzieMaple RidgeMassetMcBrideMcLeese LakeMcLeod LakeMerrittMica CreekMidwayMissionMontneyMoyieMuncho LakeNakuspNaramataNelsonNew AiyanshNew DenverNew WestminsterNimpo LakeNorth SaanichNorth VancouverOcean FallsOcean ParkOkanagan FallsOliverOsoyoosOyamaParsonPeachlandPembertonPentictonPitt MeadowsPort AlicePort ClementsPort CoquitlamPort EdwardPort HardyPort McNeillPort MellonPort MoodyPort RenfrewPouce CoupePowell RiverPrespatouPrince GeorgePrince RupertPrinceton,British ColumbiaProphet RiverQuadra IslandQualicum BeachQueen CharlotteQuesnelRadium Hot SpringsRed Rock,British ColumbiaRevelstokeRichmondRiondelRiske CreekRock CreekRollaRosslandSaanichSalmoSalmon ArmSalmon ValleySandspitSavonaSaywardSecheltShalalthSicamousSidneySkookumchuckSlocanSmithersSointulaSookeSorrentoSouth SlocanSparwoodSpences BridgeSpillimacheenSquamishStewartSummerlandSummit LakeSurreyTachieTahsisTatla LakeTaylorTelegraph CreekTelkwaTerraceThrumsToad RiverTofinoTopleyTrailTrout LakeTsay Keh DeneTumbler RidgeUclueletValemountVallicanVan AndaVancouverVanderhoofVavenbyVernonVictoriaView RoyalWellsWest KelownaWest VancouverWestwoldWhistlerWhite RockWilliams LakeWillowbrookWinfieldWinter HarbourWonowonWynndelYahkYaleYoubouZeballosProvince(Required)British ColumbiaPostal Code(Required)Immigration Related InformationStatus in Canada(Required)PR - Permanent ResidentPR - Approved in PrinciplePR - Other Humanitarian PathwaysPNP - Provincial NomineePNP - Provincial Nominee EntrepreneurCitizen - by birthCitizen - NaturalizedRefugee - GAR / Government Assisted RefugeesRefugee - PSR / Private Sponsored RefugeesRefugee - RC / Refugee ClaimantAsylum SeekersStudent - International Post SecondaryStudent - Study PermitTemp. Resident Permit / Minister's PermitUkraine CUAET PermitWork Permit - OpenWork Permit - Post-Graduation Work PermitWork Permit - Entrepreneur/Self-employedWork Permit - Closed / Temporary Foreign WorkerVisitor - Temporary Resident VisaRefugee - Protected Person (Convention Refugee)Provincial Nominee Awaiting PRMOME 2023 (Gaza, Palestine)UCI (Unique Client Identifier)(Required)UCI (Unique Client Identifier)Country of Origin(Required)AfghanistanAlbaniaAlderneyAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBritish Virgin IslandsBruneiBulgariaBurkina FasoMyanmar (formerly Burma)BurundiCameroonCanadaCanary IslandsCabo VerdeCayman IslandsCentral African RepublicChadChileChina (PRC)ColombiaComorosCongo Democratic Republic ofCongo (Congo Republic)Costa RicaCroatiaCubaCyprusCzechia (Czech Republic)DenmarkDjiboutiDominican RepublicEcuadorEgyptEl SalvadorEnglandEquatorial GuineaEritreaEstoniaEthiopiaGermanyFijiFinlandFr. PolynesiaFranceFrench GuianaGabonGambiaGeorgiaGhanaGreeceGreenlandGrenadaGuadaloupeGuamGuatemalaGuineaGuinea-bissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyCote d Ivoire (Ivory Coast)JamaicaJapanJordanKazakhstanKenyaKerguelen IslandsKyrgyzstanKiribatiKorea, NorthKorea, SouthKosovoKuwaitLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMoldovaMonacoMongoliaMontserratMoroccoMozambiqueNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNorthern IrelandNorwayPakistanPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaScotlandSenegalSerbiaSeychellesSierra LeoneSingaporeSolomon IslandsSomaliaSouth AfricaSpainSri LankaSt. HelenaSt. Kitts and NevisSt. LuciaSt. Pierre Et MiquelonSt. Vincent And The GrenadinesStatelessSudanSurinameEswatini (formerly Swaziland)SwedenSwitzerlandSyriaTajikistanTanzaniaThailandTibetTogoTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks & CaicosTuvaluU.S. Virgin IslandsUnited States of AmericaUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuHoly See (Vatican City)VenezuelaVietnamWalesWestern SaharaYemenYugoslaviaZambiaZimbabweOmanSudan, SouthUnited KingdomSloveniaSlovakia (Slovak Republic)Taiwan (ROC)CambodiaDominicaEast Timor (Timor-Leste)MicronesiaMontenegroPalauDate of Arrival in BC First Arrived in Canada on(Required) Arrived in Canada as(Required)Arrived as a single personArrived as a family unitClaim Submitted?(Required)At Port of EntryInlandNot Submitted yetPrefer not to answerUnknownHow Did You Hear About UsNot ReferredCommunity centre / libraryEmployer / co-workerEthnic or religious organizationFamily / friendsCanadian government agencyGovernment publication / brochure / websiteImmigration consultant / lawyerInternal to my organizationNon-governmental newspaper / media / publication / brochure / Web siteIn-Canada orientation sessionOverseas orientation session (e.g. CIIP)Other settlement service providerSchoolRecruitment via Destination Canada and Canadian embassiesRecruitment via website and social mediaWalk-inImmigration DocumentExample: PR Card or Work Permit, with UCI#. Please ensure both sides of PR Card are included. (1 file, max 10 mb) Drop files here or Select files Accepted file types: pdf, docx, doc, jpg, gif, tiff, Max. file size: 10 MB, Max. files: 1. Identification DocumentExample: BC Card, Passport, Drivers License etc. (1 file, max 10 mb) Drop files here or Select files Accepted file types: pdf, docx, doc, jpg, gif, tiff, Max. file size: 10 MB, Max. files: 1. Other DocumentsExample: Resume, Cover Letter, IELTS etc. (max 3 files, and max. 10 mb per file) Drop files here or Select files Accepted file types: pdf, docx, doc, jpg, gif, tiff, Max. file size: 10 MB, Max. files: 3. Emergency Contact Information#1: NamePhone NumberEmail #2: NamePhone NumberEmail ServicesWhat other services are you interested in: (select all that apply)Support to learn about life in CanadaSupport to access health, housing, or other basic needsSchool RegistrationEnglish ClassesHelp with finding a jobLearning about workshops, activities and eventsWhile available services with us, would you need any kind of Supports: (select all that apply)TransportationInterpretationChildmindingDigitalWould you like to provide any additional information for availing services with us?Details of Family MembersWould you like to register your family members so that they can also receive services with us? Yes No How many members would you like to add?(Required)123456Member 1First Name(Required)Last Name(Required)Date of Birth(Required) Status in Canada(Required)PR - Permanent ResidentPR - Approved in PrinciplePR - Other Humanitarian PathwaysPNP - Provincial NomineePNP - Provincial Nominee EntrepreneurCitizen - by birthCitizen - NaturalizedRefugee - GAR / Government Assisted RefugeesRefugee - PSR / Private Sponsored RefugeesRefugee - RC / Refugee ClaimantAsylum SeekersStudent - International Post SecondaryStudent - Study PermitTemp. Resident Permit / Minister's PermitUkraine CUAET PermitWork Permit - OpenWork Permit - Post-Graduation Work PermitWork Permit - Entrepreneur/Self-employedWork Permit - Closed / Temporary Foreign WorkerVisitor - Temporary Resident VisaRefugee - Protected Person (Convention Refugee)Provincial Nominee Awaiting PRMOME 2023 (Gaza, Palestine)Sex at Birth(Required)FemaleMaleUnknownXMarital Status(Required)MarriedCommon-LawSingleRelationship(Required)SpouseChildSiblingParentCommon Law SpouseUCIMember 2First Name(Required)Last Name(Required)Date of Birth(Required) Status in Canada(Required)PR - Permanent ResidentPR - Approved in PrinciplePR - Other Humanitarian PathwaysPNP - Provincial NomineePNP - Provincial Nominee EntrepreneurCitizen - by birthCitizen - NaturalizedRefugee - GAR / Government Assisted RefugeesRefugee - PSR / Private Sponsored RefugeesRefugee - RC / Refugee ClaimantAsylum SeekersStudent - International Post SecondaryStudent - Study PermitTemp. Resident Permit / Minister's PermitUkraine CUAET PermitWork Permit - OpenWork Permit - Post-Graduation Work PermitWork Permit - Entrepreneur/Self-employedWork Permit - Closed / Temporary Foreign WorkerVisitor - Temporary Resident VisaRefugee - Protected Person (Convention Refugee)Provincial Nominee Awaiting PRMOME 2023 (Gaza, Palestine)Sex at Birth(Required)FemaleMaleUnknownXMarital Status(Required)MarriedCommon-LawSingleRelationship(Required)SpouseChildSiblingParentCommon Law SpouseUCIMember 3First Name(Required)Last Name(Required)Date of Birth(Required) Status in Canada(Required)PR - Permanent ResidentPR - Approved in PrinciplePR - Other Humanitarian PathwaysPNP - Provincial NomineePNP - Provincial Nominee EntrepreneurCitizen - by birthCitizen - NaturalizedRefugee - GAR / Government Assisted RefugeesRefugee - PSR / Private Sponsored RefugeesRefugee - RC / Refugee ClaimantAsylum SeekersStudent - International Post SecondaryStudent - Study PermitTemp. Resident Permit / Minister's PermitUkraine CUAET PermitWork Permit - OpenWork Permit - Post-Graduation Work PermitWork Permit - Entrepreneur/Self-employedWork Permit - Closed / Temporary Foreign WorkerVisitor - Temporary Resident VisaRefugee - Protected Person (Convention Refugee)Provincial Nominee Awaiting PRMOME 2023 (Gaza, Palestine)Sex at Birth(Required)FemaleMaleUnknownXMarital Status(Required)MarriedCommon-LawSingleRelationship(Required)SpouseChildSiblingParentCommon Law SpouseUCIMember 4First Name(Required)Last Name(Required)Date of Birth(Required) Status in Canada(Required)PR - Permanent ResidentPR - Approved in PrinciplePR - Other Humanitarian PathwaysPNP - Provincial NomineePNP - Provincial Nominee EntrepreneurCitizen - by birthCitizen - NaturalizedRefugee - GAR / Government Assisted RefugeesRefugee - PSR / Private Sponsored RefugeesRefugee - RC / Refugee ClaimantAsylum SeekersStudent - International Post SecondaryStudent - Study PermitTemp. Resident Permit / Minister's PermitUkraine CUAET PermitWork Permit - OpenWork Permit - Post-Graduation Work PermitWork Permit - Entrepreneur/Self-employedWork Permit - Closed / Temporary Foreign WorkerVisitor - Temporary Resident VisaRefugee - Protected Person (Convention Refugee)Provincial Nominee Awaiting PRMOME 2023 (Gaza, Palestine)Sex at Birth(Required)FemaleMaleUnknownXMarital Status(Required)MarriedCommon-LawSingleRelationship(Required)SpouseChildSiblingParentCommon Law SpouseUCIMember 5First Name(Required)Last Name(Required)Date of Birth(Required) Status in Canada(Required)PR - Permanent ResidentPR - Approved in PrinciplePR - Other Humanitarian PathwaysPNP - Provincial NomineePNP - Provincial Nominee EntrepreneurCitizen - by birthCitizen - NaturalizedRefugee - GAR / Government Assisted RefugeesRefugee - PSR / Private Sponsored RefugeesRefugee - RC / Refugee ClaimantAsylum SeekersStudent - International Post SecondaryStudent - Study PermitTemp. Resident Permit / Minister's PermitUkraine CUAET PermitWork Permit - OpenWork Permit - Post-Graduation Work PermitWork Permit - Entrepreneur/Self-employedWork Permit - Closed / Temporary Foreign WorkerVisitor - Temporary Resident VisaRefugee - Protected Person (Convention Refugee)Provincial Nominee Awaiting PRMOME 2023 (Gaza, Palestine)Sex at Birth(Required)FemaleMaleUnknownXMarital Status(Required)MarriedCommon-LawSingleRelationship(Required)SpouseChildSiblingParentCommon Law SpouseUCIMember 6First Name(Required)Last Name(Required)Date of Birth(Required) Status in Canada(Required)PR - Permanent ResidentPR - Approved in PrinciplePR - Other Humanitarian PathwaysPNP - Provincial NomineePNP - Provincial Nominee EntrepreneurCitizen - by birthCitizen - NaturalizedRefugee - GAR / Government Assisted RefugeesRefugee - PSR / Private Sponsored RefugeesRefugee - RC / Refugee ClaimantAsylum SeekersStudent - International Post SecondaryStudent - Study PermitTemp. Resident Permit / Minister's PermitUkraine CUAET PermitWork Permit - OpenWork Permit - Post-Graduation Work PermitWork Permit - Entrepreneur/Self-employedWork Permit - Closed / Temporary Foreign WorkerVisitor - Temporary Resident VisaRefugee - Protected Person (Convention Refugee)Provincial Nominee Awaiting PRMOME 2023 (Gaza, Palestine)Sex at Birth(Required)FemaleMaleUnknownXMarital Status(Required)MarriedCommon-LawSingleRelationship(Required)SpouseChildSiblingParentCommon Law SpouseUCIPrivacy and Confidentiality StatementCentral Vancouver Island Multicultural Society (CVIMS) is committed to protecting your privacy. We collect and keep personal information about clients confidential, unless there is a serious concern about someone’s safety. If there is a risk of harm to yourself or to others, we are required by the Code of Ethics of Canada to break confidentiality. In addition, under Canadian law, everyone must report concerns about a child’s safety. With your permission, CVIMS staff may use your information to connect you with other CVIMS programs or to refer you to community partners and other organizations that offer services that may support your needs. We will only share your information with your consent. Canada’s Anti-Spam Legislation (CASL) requires that CVIMS receive your express consent before sending you messages electronically (such as emails, text messages, or messages through social media). With your consent, we may send you messages including: Appointment reminders and updates Information about workshops or programs Newsletters and announcements Invitations to events Appeals for donations We will not share your contact information with outside organizations for marketing or fundraising purposes. Your information will remain confidential and used only for the purposes mentioned above. By signing below, you confirm that: You give CVIMS permission to collect, use, and share your personal information as described above. You give CVIMS express consent to communicate with you by email, text, or other electronic means. You understand you can withdraw your consent at any time by contacting CVIMS at info@cvims.org I confirm that I have read and understood the privacy and confidentiality statement.YesNoI consent to be added to the contacted electronically, for the purposed mentioned above.YesNoDate Signed(Required) Signature(Required)Your NameYour NameYour NameYour NameCaptchaPrograms (Admin Only)Date Visited (Admin Only) Official Language (Admin Only)Current Emp Status (Admin Only)DOC_1 TYPEDOC_2 TYPEDOC_3 TYPE