Intake Form

Please complete the details below to fill out the Intake Form.

If you do not have a Home Phone Number, enter ‘0’
If you do not have a Cell Phone Number, enter ‘0’
eg. Box 69, Russell, MB R0J 1W0
If Not Employed/Unemployed, enter ‘0’
If Not Employed/Unemployed, enter ‘0’
eg. 2002
Year Only

An Employment Officer will contact you by phone/email to arrange an appointment time. Please check your junk/spam email folder as well incase our communication email ends up in there.

Alternatively, you can fill out the PDF below* and email it to

* Don’t forget to save the PDF before attaching it to your email or it will send as a blank form