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Free Refugee Assessment Form
  • Areas marked with an * are required fields
  • Remember to click the "Submit" button at the bottom of the screen when you have finished filling out the form
Personal Information
Your Name*
Date of Birth*
Nationality*
Address: Number and Street*
City/Town*
State/Province*
Country*
Post Code/Zip Code*
Telephone Number*
Fax Number
E-Mail Address*
Level of Education
High School Diploma
Trade School/College Diploma
Bachelor Degree
Master Degree
PH. D. Degree
Total years of full-time study in school
Official Languages
ENGLISH High Proficiency Moderate Proficiency Basic Proficiency No ability to speak
Speak
Listen
Read
Write
FRENCH High Proficiency Moderate Proficiency Basic Proficiency No ability to speak
Speak
Listen
Read
Write
Employment history for the last 10 years
Military service history
Years in military service
In which Country
Residential history for the last 10 years
Passport/Travel documents
Do you have a valid passport? Yes No
Country of issue
Other travel documents
Any additional comments you would like to make

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