First Name

Last Name

Email

Phone

Are you a Canadian Citizen or Permanent Resident? Yes No

Have you lived in Canada for less than 10 years? Yes No This program is designed for women who are new to Canada within 10 years.

Canadian Language Benchmarks Level 4 5 6 7 8 9 10 Please indicate what your language level in English is.

I Identify As a women I'd Rather Not Say This program is designed for people who identify as a woman.

What are you interested in? Starting a new business Expanding an existing business

Program Participation Goals/Outcomes What are your goals for the Hire Yourself program?

Do you identify with any of the following underrepresented groups? Please check all that apply. (Note* Priority to participate in this program will be given to women from the following underrepresented groups) Women in Technology Indigenous women Rural women Newcomer to Canada Visible and/or racialized minority Women with a disability Women under 40 I do not identify with any of the above groups To select multiple choices, hold Ctrl and select your choices.

Are you interested in any of the following? (Check all that apply): Growing my business in other countries Strengthening my entrepreneurial skills Networking/Matching opportunities To select multiple choices, hold Ctrl and select your choices.

Certification/Signature I Agree I Disagree By selecting "I Agree" to this question will act as your electronic approval upon submission of this form.

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