Morden Community Driven Immigration

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

Submission Date: (MM/DD/YYYY) / /

1) Contact Information
Address:

Email: Skype Address:

Federal Express Entry Number: (this application will NOT be evaluated or

kept into the Federal Express Entry Pool).
without this number AND a scan of the letter showing you have been accepted
Exception: Welders, Carpenters or those with strong French language ability.
Full Legal Name of PRINCIPAL APPLICANT:
Date of Birth: (MM/DD/YYYY) / / Country of Birth:

Gender: Male Female

Language test score (IELTS/CELPIP or TEF/TCF)

Full Legal Name of SPOUSE:
Date of Birth: (MM/DD/YYYY) / / Country of Birth:

Language test score (IELTS/CELPIP or TEF/TCF) (not required for spouse)

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

definition of dependent children).
Birthdates:
(MM/DD/YYY
Y)
Child #1 Child #2 Child #3 Child #4 Child #5

2) Connection to Canada

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

(1)
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?

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: $

4) Education and Employment

a) What type/field of employment would you be most interested in gaining on arrival to Morden?

Declared NOC code of Principal applicant

(see http://noc.esdc.gc.ca/English/NOC/NewNOC.aspx?ver=16)

Principal Applicant:
Spouse:

b) 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

c) Education of Spouse - Give full details of all education (including secondary/high

school, university/college/apprenticeship training).

From: To : Name of Institution City and Countr y Type of

certificate
Year/Month Year/Month or diploma
issued
 d) Work History of Principal Applicant - Give full details of all work history

From: To : Occupation/ Type of Name of

C o m pny emplcooym
erp, asn
chyo, ol,
Year/Mon Year/Mon Job Title
--e.g.
th th

e) Work History of Spouse - Give full details of all work history

From: To : Occupation/ Type of Name of

C o m pny emplcooym
erp, asn
chyo, ol,
Year/Mon Year/Mon Job Title
--e.g.
th th

5) Application History and Travel History

a) Have you ever worked or studied outside of your home country (including Canada)? Yes No

Ye ars 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 dependents for:
i) Morden’s Community Driven Immigration Initiative? Yes

No ii) Manitoba Provincial Nominee Program: Yes

No iii) Any other Provincial Nominee 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?

6) Other Information

a) 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?

b) Please indicate how you learned about the following Morden Community Driven
Immigration: Consultant, please identify the consultant

Website, please identify the website

c) 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

Scan of the letter showing you have been accepted into the Federal Express Entry Pool

Educational Equivalency document (ex. WES, IQAS) (for express entry applicants)
Please do not include education documents or certificates, reference letters, or other such documents.
d) 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:

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.

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.

Please send completed forms to:

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