Want to learn more? Questions?

www.immigrant-education.ca

FINANCIAL COACHING

Consent for Release of Information

I (participant), ___________________________, hereby authorize The Immigrant Education Society (TIES) to both
share and receive information regarding myself when it is considered necessary and beneficial with other individuals
or organizations, (i.e. financial institutions, educational resources, social services, CRA, Service Canada, IRCC, Alberta
works etc.). I understand that all information shared will be treated in a confidential manner.

**Note: Information may be provided through oral and/or written communications. If applicable, any exceptions to the
release of information are listed here: _______________________________________

First Name: __________________________ Last Name: _______________________________

ID Type (PR/UCI): ______________________ ID Number: ________________________________

*Please provide UCI if you are a newcomers to Canada

Date of Birth: (______/____/____) Gender: ___________________________________

YYYY MM DD
Country of Origin: _____________________ First Language: ____________________________

Employment Status: ______________________ Family Members: ___________________________

*Student, unemployment, etc

Address: _____________________________ Postal Code: ______________________________

Phone Number: ________________________ E-mail Address: ___________________________

Please check the box of the services you are wanting to access from Money Smart:

☐ Saving Money ☐ Building/Maintain your credit history ☐ Dealing with Debt 󠄊 󠄊 󠄊 󠄊

☐ Creating a Budget ☐Home Ownership and Renting in Canada ☐ Taxation and Benefits

☐ Scams and Fraud in Canada ☐Register and Non-Registered Funds (RESP, TSFA)

☐ Learning about Canadian Banking System ☐ Other (Please Explain):_______________________

______________________________ _________________________ ______________________

Participant Name (printed) Participant/Guardian (signature) Date

Noha El Tanahi
Program Team Lead, Settlement & Money Smart

Funded
By:

Charity # 130143373 RR0001