Please consult the "Provinces" pages for more information.

In which program would you wish to participate? Work placement

Province New Brunswick Newfoundland and Labrador Nova Scotia Prince Edward Island

Name

Address

E-mail address

Cell Phone

Telephone at permanant residence

Telephone at school (if applicable)

Date of Birth

Languages spoken French English

First language learned

Educational Institution

Program

Year(s) completed

Year(s) to complete

Do you have any work experience in your field of studies? Yes Length of time No

Would you like to start your own business someday? Yes No Undecided What type of business

Which field of work interests you?

Do you live outside of your province or town of origin? Yes No

If so, how long ago did you leave your province or town of origin?

How did you find out about PERCÉ?

Why would you like to participate in the PERCÉ program?

Why would you like to stay or return to your province or town of origin?