Canada-Ukraine Authorization for Emergency Travel Intake Form Canada-Ukraine Authorization for Emergency Travel Intake Form If you are a Ukrainian citizen or an immediate family member of a Ukrainian citizen, then you are eligible to apply for the Canada-Ukraine Authorization for Emergency Travel. Approval of the application will get a visa to Canada and an open work permit for adult applicants, and a study permit for child applicants. There is no government processing fee for the application. Fill out the form below to begin the application. Full Name * Nationality * Family Status – If you are not Ukrainian, which type of family member to a Ukrainian citizen are you? * Not Applicable – I am Ukrainian Spouse or Common-law partner Dependent Child (under 22 years old) Other COVID-19 Vaccination Status – Are you fully vaccinated against covid-19? * Yes – Fully Vaccinated Yes – Partially Vaccinated (have not yet received all required doses) No – Unvaccinated Even if you are unvaccinated, you can still apply for CUAET If you are fully vaccinated against covid-19, which types of vaccines have you received? (list all if more than 1) Do you hold a valid passport? * Yes No Even if you do not hold a valid passport, you can still apply for CUAET Email * Phone * Current Street Address * City/Town * Province/State Zip/Postal Gender Date of birth * Current Country of Residence * Choose oneAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongoCosta RicaCôte d'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceFrench GuianaFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Status in Canada – If you are already inside Canada Expiry Date In Canada (if applicable) Do you have a Spouse/Common-Law Partner? No Spouse Common-law partner Spouse/Partner’s Name (if applicable) Spouse/Partner’s Nationality How long have you been married or in a common-law relationship? Have you or your spouse ever been convicted of a criminal offence? No Yes Please tell us any details about your situation that have not already been addressed. * How did you hear about us? * Referred by a friend or family member Google search/maps/reviews Facebook Instagram Moving 2 Canada VisaWire Returning Client Other By typing my name, I hereby certify that this document is legally executed by the person named herein as the Client, and that I understand and acknowledge all of the above information to be true, correct, and complete. * Today’s Date * Doherty Fultz Immigration is currently waiving all consultation fees related to CUAET and flight from the Russian invasion of Ukraine. By signing above, I indicate that I understand the information provided by Doherty Fultz Immigration is provided in good faith and is accurate as of the time it is given. Due to the volatile nature of this program, requirements, eligibility, and rules may change at any time and without notice. Doherty Fultz Immigration is not liable for any information which has become inaccurate through the passage of time, changes to the CUAET program, or clarifying statements issued by the government of Canada. As the program is entirely new, requirements and eligibility can change at any time. Doherty Fultz Immigration will endeavor to ensure the information provided is accurate at the time of its delivery. All information discussed or disclosed in the context of a consultation at Doherty Fultz Immigration is STRICTLY CONFIDENTIAL, and is bound by representative-client privilege. These terms and conditions shall be governed by the laws in effect in the Province of Ontario, Canada. Please note that at this time, our staff only speaks English; we regret that we do not yet have a Ukrainian or Russian speaking staff member. Зверніть увагу, що наразі наші співробітники розмовляють лише англійською; ми шкодуємо, що у нас ще немаєукраїномовного чи російськомовного співробітника. Обратите внимание, что в настоящее время наш персонал говорит только по-английски; мы сожалеем, что у нас еще нет украинского или русскоговорящего сотрудника. Please be advised that Anthony Doherty (R510956), Cassandra Fultz (R514356), Katherine McLean (R708625), and Brooke Westcott (R708924) of Doherty Fultz Immigration Inc. (located at 2558 Danforth Avenue, Suite 202, Toronto, ON, Canada M4C1L3; Telephone: 416-827-8778; email: [email protected] ) are members in good standing of the Immigration Consultants of Canada Regulatory Council (ICCRC)/College of Professional Immigration Consultants, and as such, are licensed and regulated by this organization and are bound by its By-laws, Code of Professional Ethics, and associated Regulations. By signing this intake agreement, you acknowledge that any interaction with IRCC or CBSA undertaken by you without retaining an Doherty Fultz Immigration RCIC as a legal representative is done at your own risk, and Doherty Fultz Immigration accepts no responsibility for the outcome of any such interaction. Opt In Yes, I would like to receive emails about important immigration changes and new programs. I understand I can unsubscribe at any time, and that my contact information is completely confidential forever. If you are human, leave this field blank. Submit
416-827-8778 
