JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Smartphones for Life Registration Form
Please make sure all the details are correct
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Sara
*
Your answer
Last name: tesfa
*
Your answer
Phone Number: 2044313178
*
Your answer
Email Address:saratesfa882@gmail.com
*
Your answer
Date of Birth:04/18/1981
*
MM
/
DD
/
YYYY
Gender:
*
Male
Female
Other
First Language:
*
Your answer
Country of Origin:
*
Your answer
Street Address:
*
Your answer
City/Rural:
*
Your answer
Postal Code:
*
Your answer
Did you finish High School?
*
Yes
No
Do you identify as an Indigenous person?
*
Yes
No
Status in Canada:
*
Refugee Claimant
Permanent Resident
Student Visa
Work Permit
Citizen
Other
Are you a newcomer to Canada? (less than 3 years)
*
Yes
No
Do you consider yourself as low income?
*
Yes
No
Do you have a disability?
*
Yes
No
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Altered Minds, Inc..
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
