CAQ Have you been refused a study permit?* No Yes Have you been refused a CAQ?* No Yes File No.: Refused Date: 1.Full name 2.Have you ever used any other name(e.g. Nickname, maiden name, alias, etc)?* No Yes please provide the name Family name Given name Personal information 3.Sex* Female Male 4.Marital status De facto spouse Divorced Separated Married Single Widow Provide the date on which you were married or entered into the common-law relationship Provide the name of your current Spouse/Common-law parther Is your spouse or common-law partner a Canadian citizen or permanent resident? No Yes Have you previously been married or in a common-law relationship? No Yes Provide the following details for your previous Spouse/Common-law partner: Type of relationship common-law married From To 5.Your date of birth 6.Place of birth 7.Citizenship* 8.Main language spoken Contact Information 9.Current residential address 10.Telephone no. Canada/Us Other 11.E-mail address Accompanying persons 12.Are there persons in your immediate family who are already in Québec or who will accompany you during your entire period of study? No Yes Click ‘ADD’ button and write the personal details. Program of studies 13.Indicate which level of studies you have been admitted to in Quebec Attestation of collegial studies(ACS) College Non-degree program Other Primary Secondary Secondary, professional University, doctorate University, master’s University, undergraduate/professional Program of studies: Indicate if you participate in an exchange program No yes Additional information 14.Specify whether you have ever obtained a Quebec Acceptance Certificate(CAQ) for studies* No Yes Provide information about your most recent approved CAQ file No.: Start date of your most recent CAQ for studies: End date of your most recent CAQ for studies: Program or level of studies indicated on the CAQ Attestation of collegial studies(ACS) College Non-degree program Other Primary Secondary Secondary, professional University, doctorate University, master’s University, undergraduate/professional Indicate whether you are changing your level of studies or your program No Yes Indicate whether you have stayed in Quebec to study over the past six months No Yes Financial information 15.Indicate who will mainly be responsible for paying your living expenses and tuition fees in Quebec. Principal payer: An organization or gouvernment Another person My father My mother Myself Indicate the principal payer’s name and contact information. Principal payer’s address:
