Morden Community Driven Immigration Initiative

Note: By applying to the Morden Community Driven Immigration Initiative, you are applying for Morden’s
support for your future application to the Manitoba Provincial Nominee Program. It is your
responsibility to ensure that you meet and continue to meet the criteria of the MPNP before you
apply for Morden’s Initiative. Please see www.mordenimmigration.com for criteria and target occupations.

Submission Date: (M/D/Y)

1) Contact Information

Address:
Phone: Email:
Skype Address:

Full Legal Name of PRINCIPAL APPLICANT:

Date of Birth: (M/D/Y) Country of Birth: Gender: Male Female
English Test Score: IELTS (International English Language Testing System, www.ielts.com )

Full Legal Name of SPOUSE (if applicable):

Date of Birth: (M/D/Y) Country of Birth: Gender: Male Female
English Test Score: IELTS (not required for spouse)

DEPENDENT CHILDREN (if applicable) (see http://www.immigratemanitoba.com/apply-to-mpnp/family/ for

definition of dependent children).
Birthdates: Child #1 Child #2 Child #3 Child #4 Child #5
(M/D/Y)

2) Education and Employment

a) Education of Principal Applicant - Give full details of all education (including secondary/high school,
university/college/apprenticeship training).
From: To: Name of Institution City and Country Type of certificate
Year/Month Year/Month or diploma issued

b) Education of Spouse - Give full details of all education (including secondary/high school,
university/college/apprenticeship training).
From: To: Name of Institution City and Country Type of certificate
Year/Month Year/Month or diploma issued

c) Employment History of Principal Applicant

From: To: Occupation/Job Title Type of Company – eg) Name of company,
Year/Month Year/Month manufacturing, health care employer, school, facility, as

1 Morden Community Development Corporation, Morden, MB, Canada

Email: info@mordenimmigration.com
 Morden Community Driven Immigration Initiative

applicable

d) Employment History of Spouse

From: To: Occupation/Job Title Type of Company – eg) Name of company,
Year/Month Year/Month manufacturing, health care employer, school, facility, as
applicable

What type/field of employment would you be most interested in gaining on arrival to Morden?
Principal Applicant:
Spouse:

3) Available Settlement Funds

a) The Provincial Nominee Program (MPNP) requires that applicants have sufficient settlement funds
available when they move to Manitoba. Settlement funds and other assets must be only in the name of
the principal applicant or spouse.

Please List IN CANADIAN EQUIVILENT funds:

• Cash / Account: $
• House / Apartment Value: $
• Other: $
$

4) Application History and Travel History

a) Have you ever worked or studied outside of your home country (including Canada)? Yes No
Years Province / Country Purpose/Type of Training/Job

b) If invited to take part in our program, you will be required to come to Morden for an exploratory visit.
Have you ever applied for a travel visa to Canada? Yes No If yes:
Year: _________________________ Purpose: ___________________________________
Result: _____________________________________________________________________

c) Has an immigration application ever been submitted for principal applicant or dependants for:
i) Morden’s Community Driven Immigration Initiative? Yes No
ii) Manitoba Provincial Nominee Program: Yes No

2 Morden Community Development Corporation, Morden, MB, Canada

Email: info@mordenimmigration.com
 Morden Community Driven Immigration Initiative

iii) Any other Provincial Nominee Program? Yes No

iv) Federal or any other Canadian Immigration Program? Yes No
For ALL previous applications above, please answer ALL of the following – 1) Who was the Principal
Applicant? 2) When was the application submitted? 3) Has the application been denied? 4) Why was
the application denied? 5) How has this situation changed?

5) Other
a) Please indicate all the parts of Canada you have family, friends or associates.
(Associates are people you do not know personally or may have never met – for example friends of
friends) No family, friends or associates in Canada

Family Friends Associates Where do they live? (City/Province)

In Morden area
Other parts of Manitoba
Other parts of Canada
If family, what is the relationship? Please specify
How long have the above friends or family been in Canada? If they are in Manitoba, are they able to
support your application directly to the MPNP?

b) Please indicate the services, characteristics, facilities, and other qualities that are important to
have in a new community to meet the needs of you and your family. Why do you feel that
Morden will meet your needs?

c) What is the Principal Applicant’s and Spouse’s self-employment experience?

Currently self-employed for years, please indicate type of business

Previously self-employed for years, please indicate type of business
Have international and/or e-business experience
Have not been self-employed

d) Please indicate how you learned about the Morden Community Driven Immigration Initiative.
Consultant, please identify the consultant
Website, please identify the website
Family/Friend referral, please specify where they live
Other, please specify

3 Morden Community Development Corporation, Morden, MB, Canada

Email: info@mordenimmigration.com
 Morden Community Driven Immigration Initiative

e) Attachments required for this application:

Scan of signed pages of this application
C.V. or resume for all persons 18 years and over
Scanned copy of principal applicant’s IELTS results
Scanned copy of principal applicant’s passport
Scanned copy of Bank statement proving adequate settlement funds
Please do not include education documents or certificates, reference letters, or other documents.

f) If you did not complete your own application, please provide the contact information of the
person(s) or agency that completed this application.
Name:____________________________ ICCRC ID number: _____________________
Email:____________________________ Phone: _____________________________
________________________________________________________
Authorization to Disclose
I/We, , do hereby authorize the Morden Community Development Corporation staff to enquire
with the Provincial Nominee Program (MPNP) staff regarding my/our potential application to the MPNP for the purposes of
determining my eligibility under the Morden Community Driven Immigration Initiative. We hereby authorize the sharing of
information between both parties for the purposes indicated above. We also consent to having direct contact with an
authorized representative of the Morden Community Development Corporation for the purposes of discussing our application
to the Morden Community Driven Immigration Initiative, and understand this contact is likely to be by telephone and email.
We also consent to having our C.V. / resume and related information shared with select Morden Employers with the purpose of
potential job possibilities.

I/We understand that:

• This consent is given for the stated purposes and for no other purpose without my/our written consent.
• This consent includes my/our dependents
• I/We may change or cancel this authorization at any time except for such action as has already been taken.

Principal Applicant Name (print) Signature: _____________________ Date: ____________

Spouse (if applicable) Name (print) Signature: _____________________ Date: ___________

I verify that the information provided in this application is correct and true to the best of my
knowledge. I also acknowledge that any misrepresentation of information may result in my
application being declined and I may not be able to participate in this initiative now or in the future.

Principal Applicant Signature Principal Applicant Name in Print Date

By completing this application, you are declaring your intention to live, work and settle in
Morden, if you arrive in Canada through the support of Morden’s Community Driven
Immigration Initiative.

4 Morden Community Development Corporation, Morden, MB, Canada

Email: info@mordenimmigration.com