Please choose your preferred time - Surrey Surrey AM (Mon-Fri; 9am - 12pm) Surrey PM (Mon-Fri; 1pm - 4pm) Surrey EVE (Tue, Wed, Thu; 6:30pm - 9:30pm) First Name Middle Name Last Name Date of birth Date of birth: Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 Date of birth: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Date of birth: Day Day12345678910111213141516171819202122232425262728293031 Gender Male Female Other Country of birth First Language Permanent Resident Number (UCI number) PR card expiry date PR card expiry date: Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 PR card expiry date: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec PR card expiry date: Day Day12345678910111213141516171819202122232425262728293031 When did you become a PR? (Landing date) When did you become a PR? (Landing date): Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 When did you become a PR? (Landing date): Month MonthJanFebMarAprMayJunJulAugSepOctNovDec When did you become a PR? (Landing date): Day Day12345678910111213141516171819202122232425262728293031 Address City Province Postal Code Home phone number Cell number Email Emergency contact information Name Phone Number Interpretation Contact Information (required for CLB level 1, 2, and 3 applicants) Name Phone number Check the documentation you have Permanent Resident Card Confirmation of Permanent Residence Notice of Decision (for refugees) Please choose one option only Are you a Canadian citizen? Yes No Do you have a Client Referral Form from a language assessment centre? Yes No Add Form One file only.128 MB limit.Allowed types: gif, jpg, png, txt, rtf, pdf, doc, docx. Please contact one of the following assessment centres before registering any LINC program: Vancouver: 604-876-5756 208 2525 Commercial Drive Vancouver, BC V5N 4C1 Surrey: 604-507-4150 202-7337 137th Street Surrey, BC V3W 1A4 Did you complete the Language Assessment / attend LINC classes within 1 year? Yes No What is your CLB assessment result? Listening Speaking Reading Writing I understand that by submitting this registration form, I consent to Douglas College providing personal information to the funder (Federal Government) for service monitoring and evaluation and for research purposes if I am accepted to study LINC. Citizenship and Immigration Canada (CIC) may want to contact you in the future. CIC will use your answers to improve services for all immigrants. This is voluntary. CIC will not use your information to make any decisions about you personally. May CIC, or an independent research company acting for CIC, contact you in future? If you study LINC, may we share your success story with the government funder (Immigration, Refugees and Citizenship Canada) after you have completed the program? Leave this field blank