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    Settlement Intake Form

    Client Intake Form

    Please note that fields with the arrow down symbol ⯆ are dropdown menus.
    Do you need services in French?(Required)
    Name(Required)
    Date of Birth(Required)
    Date 1st entered Canada
    Date 1st entered Ontario
    Were you at one point Refugee?(Required)
    Did you come as
    Email(Required)
    Would you like to receive emails about HMC programs, services and events?(Required)
    Have you had a language (LINC) assessment?(Required)
    Do you have any children?(Required)
    Please enter their names and ages (click "+" to add a row):
    Name
    Age
     
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    Do you intend to become a Canadian Citizen?(Required)
    Do you give us and our funders consent to contact you for feedback about our services?(Required)
    Consent for Release of Information:(Required)
    I give HMC full permission to disclose personal information to IRCC & other applicable service providers for support, guidance, advocacy, information, and referrals and upon my request for HMC follow-up and collect information from IRCC and other applicable service providers on the status of any support, guidance, advocacy, information or referrals provided to me. I consent to receive HMC services by phone, e-mail, and other online platforms when available/applicable.
    Please sign in the space below using your mouse, finger, stylus, or touch screen pen.
    Would you like to receive a copy of your Intake Form submission by email?
    Date: 31/03/2023
    This field is for validation purposes and should be left unchanged.
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    Halton Multicultural Council
    One Community for All

    Head Office

    1092 Speers Rd.
    Oakville, ON L6L 2X4

    North Oakville

    380 Dundas St. E. Unit #11
    Oakville, ON L6H 6Z9

    Burlington

    Burlington Centre
    777 Guelph Line, Unit 204
    Burlington, ON L7R 3N2

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    Milton, ON L9T 2M3

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    Georgetown, ON L7G 4B5

    Call us at 905-842-2486

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    © 2023 Halton Multicultural Council. All Rights Reserved. For information or inquiries please contact info@haltonmc.com.

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