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School supplies
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First Name
*
Last Name
*
Client's date of birth
*
Genre
Féminin
Masculin
Other
Phone Number
*
Email
*
Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Preferred language of communication
*
French
English
Type of request
*
Backpack(s)
Does the client fall under the low-income cut-off standard?
Yes
No
Are you a low-income family? You are if your after-tax family income is less than or equal to the following threshold by family size. Check the income that applies to you.
A family of one -
$29,380.00
A family of two (2) people -
$36,576.00
A family of three (3) people -
$44,966.00
A family of four (4) people -
$54,594.00
A family of five (5) people -
$61,380.00
A family of six (6) people -
$69,834.00
A family of seven (7) people -
$77,750.00
For a family of more than 7 people, add the following amount for each additional person -
$7,916.00
Other amount
$0.00
Source: https://www.settler.ca/english/lico-table-2024-for-immigration-and-visiting-canada/
Does the client have a spouse or partner?
*
Yes
No
If yes, please enter your spouse's name and email address.
If yes, please enter your spouse's telephone number.
Number of children:
*
Please enter the name(s), gender(s), date of birth(s), school name and grade level of all children in the household
Other information:
Signature
Clear Signature
Would you like to be contacted for other services offered by CICAN?
*
Yes
No
By filling out this form, you agree to share your data with us. All data collected will be used only for the purpose of this booking and will not be shared with any third party unless you explicitly authorize it.
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