All Programs Intake Form

    Participant Information

    1. Date
    2. First Name
    3. Last Name
    4. Age
    5. Email Address
    6. Phone Number
    7. Town/City you live in
    8. Preferred Personal Pronouns
    9. Canadian Residency Status
    If "Other", please specify
    10. Program of Interest
    If "Other", please specify
    11. How did you learn about this program?
    12. Have you ever been involved in any other employment program at KCDS?
    13. Are you currently working? Where?
    14. Are you currently enrolled in an education or training program or do you plan on pursuing training or education in the future? Please explain:
    15. Please identify any additional barriers to employment that you experience
    Limited English skillsLack of Canadian networks, work experience or knowledge of Canadian labour markertImpacts of racism or discriminationMental health considerationsDisability - self identified or diagnosedExperiencing financial hardshipLack of transportation or living in a rural areaOther
    If "Other", please specify
    16. Do you have any questions?