Client Intake Form

1. What do you need help with?

Select a service *

2. Your details

First name *

Last name *

Email address *

Phone number

Country of citizenship

Current address in Canada

Do you have any dependents accompanying you (spouse, children)?

Yes

No

3. Study details

Name of school / institution

Program name

Program start date

Program end date (or graduation date)

Current study permit expiry date If your permit has already expired, enter the date it expired.

4. Study permit extension details

Have you completed your current program, or are you continuing the same program?

Continuing same program

Starting a new program

Delayed / program extended

Is your tuition for the upcoming term paid in full?

Yes

Partially

No

Anything else relevant to your extension? (e.g. change of school, academic probation, etc.)

4. PGWP details

Date you received (or expect to receive) your final marks / official transcript This date starts your 180-day PGWP application window.

Was your program completed primarily in person, or partly/fully online?

In person

Hybrid

Fully online

Total length of your program

4. Status restoration details — urgent

Time-sensitive: Restoration of status must be requested within 90 days of your permit expiring. Please complete this section as accurately as possible so we can respond quickly.

How many days ago did your study permit expire?

Are you currently still in Canada?

Yes

No

Briefly explain why the permit was not renewed before it expired

4. Refusal & reapplication details

Date of refusal letter

What reason(s) did IRCC give for the refusal? (if known)

Have you requested your GCMS notes?

Yes, received them

Requested, waiting

Not yet

5. Anything else?

Is there anything else we should know about your situation?

How did you hear about us?

We will reply to you via email within one business day.

Something went wrong submitting the form. Please try again, or email us directly at info@twelvemileimmigration.com.

Your information is sent securely and used only to assess your case. We respond within one business day.

Thanks — we've received your information