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 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 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 >