Temporary Visit to Canada - Assessment Form


By​ ​filling​ ​out​ ​this​ ​form​ ​you​ ​confirm all​ ​the​ ​information​ ​is​ ​accurate​ ​and​ ​truthful.​ ​Filling​ ​this​ ​form​ ​does​ ​not​ ​guarantee​ ​a Canadian​ ​visa​ ​or​ ​status​ ​in​ ​any​ ​shape​ ​or​ ​form.​ ​It​ ​merely​ ​helps​ ​us​ ​assess​ ​your​ ​potential options.

Current Applicant:

What is the purpose of visit?

What is your status in relation to Canada?

Are you any of the following?

Are you a lawful permanent resident of the United States?

What is your Nationality?

(If your country is not on the list, pick the first option)

Are you travelling by air?

Given (first) Name

Middle Name (Optional)

Surname (last) Name


Date of Birth

Country of Birth?

Have you ever had an issue with the law in Canada or any other countries (e.g. being imprisoned or being convicted of criminal offence)

Have you ever had an issue with the immigration authorities of Canada or other countries (e.g. denial of visa or being deported from a country)?

Are you suffering from any serious physical or mental health problems?

Funds available for travel to Canada (estimated amount in Canadian Dollars)



List the countries you have visited in the past five years.

if you haven't traveled in the past 5 years type "not traveled " or "not applicable"

What is your martial status?

Is your spouse or common-law partner accompanying you to Canada?

Do you or spouse or common-law partner have any dependent children who are not married and under the age of 22?

How many of your dependent children (under 22 and not married) are accompanying you to Canada?

Your email address?

Alternative email address.

The best phone number to reach you.Please include the country code.

The best time to contact you?

Do you use any of the following apps?Select as many as apply.

Use (Ctrl on Windows / Command on Mac) to Select multiple

The language you prefer?

Terms​ ​and​ ​Conditions

By clicking submit you are agreeing to the Terms and Conditions.