Your Full Name:
Nationality (citizenship):
Where do you live now?
Your age:
Marital status:
Number of Children:
Ages of your children:
Home Phone number:
Email address:
How did you hear of us?
When did you arrive in Canada?
What was your status when you arrived?
Did you ever apply to extend your status?
Have you made a refugee claim?
If yes, when?
What was the reason for your refugee claim?
Did you have your hearing already?
What was the decision?
Have you applied for any appeal?
Have you ever been contacted by Greater Toronto Enforcement Centre (GTEC)?
Have you been asked to leave Canada already – been given a deportation date?
If you are working now, please give details:
Are you in a relationship with a Canadian citizen – Permanent Resident?
If yes, please give details (how long, do you live together, any children born in Canada, etc.):
Is there any reason you cannot leave Canada:
Please tell us your story of what special circumstances you have that should be considered for Humanitarian and Compassionate reasons to allow you to remain in Canada:
Please prove you are human by selecting the Cup.
