Guide to Completing the IMM5709 (10-2015) E Form

Study Permit Restoration

1. UCI Client ID (8-digit number listed in the box directly above the expiry date of
your study or work permit); or look for “UCI” number. xxxx-xxxx or
xxxxxxxx
3. I’m applying for one or more of the following: Check off---An initial study permit or extension of study permit AND
Restoration of temporary resident status as a student
Personal Details
7. Current Country of Residence? Canada
Status Other Under “Other” type in “Out of status, restoration”;
From (YYYY-MM-DD)
To (YYYY-MM-DD) Leave the “From” and “To” boxes blank.
Language(s)
3. Have you taken a test from a designated testing agency to Yes or No.
assess your proficiency in English or French? If you completed an IELTS, TOELF, CELPIP, other English/French
language test, indicated YES. If you completed an English/French
Language School program instead of an English/French test indicated NO.
Contact Information
1. Current mailing address This is your apartment or room number. For example, 111 Edward St., Apt
Apt/Unit 201
2. Resident address, same as mailing address? If your mailing address is where you live, answer ‘Yes’.
Coming into Canada
1. Date & place of your original entry to Canada Date & place of your very first entry to Canada. i.e Toronto, Ontario
2. The original purpose of coming to Canada Study
3. Date & place of your most recent entry to Canada (if not the This is the date and place of your most recent entry to Canada
same as original entry) (international travel only). For example, July 1 2014 Toronto ON
4. If applicable, provide the document number… Black number starting with only one letter listed under the large red
number at the top right of your study permit
Details of Intended Study in Canada
1. My level of study will be.. Select the appropriate “university level”
2. Designated Learning Institution # O Dalhousie University: O19209939282 (O is an upper-case letter)
Dalhousie University ESL Prog: O19091594822 (O is an upper-case letter)
 
 
T.  Inacio,  Registered  Canadian  Immigration  Consultant  
RCIC  Membership  #511568  
 
 
3. Duration of expected study Date of completing the application (today’s date)
From (YYYY-MM-DD) Estimated date of program completion. If you are to complete your
To (YYYY-MM-DD) academic program in a year’s time, add another 90 days to your expiry
request.

4. The cost of my studies will be: (for one year only)

Tuition $xx to xx,000 for undergrad students / tuition for grad students varies
Room & board $10,000
Other $1000
You may want to specific about fees. Visit http://dal.ca/moneymatters
5. Funds available for my stay (CAD) The amount indicated should be the same amount, or less, than the proof
of funds provided with your application.
6. a) In addition to a study permit, are you also applying for a No or Yes
work permit?
b) what type of work permit are you applying for: Only applicable for students in a co-op/ internship programs.
Education
Have you had any post-secondary education (including university, Answer ‘Yes” if you are a transfer or graduate student. Then enter your
college or apprenticeship training)? previous college or university study information there. ESL school
information can also be put in here.

Answer ‘No’ if you came to Dalhousie directly from high school.

Employment
Background Information
7. a) Have you ever remained beyond the validity of your status,
attended school without authorization or worked without
authorization in Canada?
b) Have you ever refused any kind of visa, admission, or been
ordered to leave Canada or any other country?
c) Have you previously applied to enter or remain in Canada?
Under ‘Current occupation/Activity’, enter Student at Dalhousie University
and your study information. Not necessary to enter part-time work.
If you have studied or worked without a valid study or work permit, you will
need to provide details and explanation. You will need to explain why you
did not renew your status before the expiry date.
If you were ever refused any visa, admission to Canada or any other
country please indicate and briefly explain.
Yes. List all visa/ permits previously applied for and when i.e. study permit
renewal, or co-op work permit or Temporary resident visa-Sept 2013.

Signature This form cannot be printed, signed or scanned. You only need to validate
and save on your computer or USB to upload later.
Note: Don’t forget to indicate your consent to be contacted by CIC.

 
 
T.  Inacio,  Registered  Canadian  Immigration  Consultant  
RCIC  Membership  #511568  
 
 
  
 
T.  Inacio,  Registered  Canadian  Immigration  Consultant  
RCIC  Membership  #511568