Complete the form to begin your evaluation. Current Eligibility Assessment Consent Form Complete Last Name First Name Date of Birth Gender Identity Woman Man Other Specify you pronouns Do you identify as a member of a racialized and/or ethnocultural minority community? Yes No Which community do you primarily identify with? Afrodescendant (Sub-Saharan Africa, Caribbean, etc.) Maghreb or Middle East (North Africa, Turkey, Lebanon, Iran, Iraq, etc.) East Asia and Southeast Asia (China, Vietnam, Thailand, etc.) Latin America (South America, Central America, Mexico) South Asia (India, Pakistan, etc.) European (Italy, France, Russia, etc.) Indigenous communities Other Specify Please check only one answer. If you identify with more than one community, select "Other(s)" and specify. Language in which you wish to be contacted French English Preferred way to contact you Telephone / Cellphone Email I don't have a phone number I don't have an email Phone number Email City of residence Were you sentenced outside of Quebec ? Yes No I don't remember Will you be able to pay the fees associated with the various steps of your record suspension application process? No Yes, but not more than $200 Yes, the fees are not an issue for me To help us estimate the total cost, can you tell us where you have lived for the past 5 years? How did you hear about our service? Social media advertising GOOGLE search Advertising on buses, bus shelters Advertising on posters in Montreal Reference from an organization Reference from a former client Reference by another service of the Société Elizabeth Fry du Québec Other… Specify I consent to the Elizabeth Fry Society of Quebec workers carrying out the necessary research to assess my eligibility. Consent to access information:Before beginning any research and verification of your online files, we must have your consent, as provided for in Law 25 on the protection of personal information. Next > Leave this field blank