Settlement Plan And Financial Assessment
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SETTLEMENT PLAN AND FINANCIAL ASSESSMENT
Group of Five
A - GENERAL INFORMATION
Name of principal applicant
Given names
Date of birth (YYYY-MM-DD)
Surname (family name)
Name of Sponsoring Group
B - SETTLEMENT NEEDS CHECKLIST
* Settlement Needs: For each settlement need, specify if your group can provide monetary or in-kind support and give the corresponding dollar figure.
Settlement Needs
Monetary Support
Annual Amount
In-Kind
In-Kind Deduction
START-UP COSTS
$
$
Clothing
$
$
Furniture
$
$
Household start-up costs
$
$
Food staples
$
$
Hook-up costs
n/a
n/a
$
School start-up costs (if applicable)
$
$
TOTAL START UP COSTS
Total:
Total:
ONGOING EXPENDITURES
$
$
Shelter (monthly rent X 12 months)
n/a
n/a
$
Transportation (public transit) (monthly costs X 12 months)
n/a
n/a
$
Living allowance (food, incidentals, etc.) (monthly costs X 12 months)
$
$
TOTAL ONGOING EXPENDITURES
Total:
Total:
$
$
GRAND TOTAL:
C - SETTLEMENT CHECKLIST
Confirm, by checking the appropriate boxes, which settlement needs your group will provide to the refugees. If one or more of the settlement needs indicated below is not applicable to
your group or if your group is not willing to provide one or more of the settlement needs, please provide an explanation in the box at the end of this section.
Meet refugees upon arrival and provide transportation to the final destination
Arrange transportation for the refugees to and from appointments and activities
Arrange for interpreter services (if applicable)
Provide orientation (public transportation, banking services, etc.)
Enroll adult refugees in language training (if applicable)
Provide assistance in finding employment
Provide assistance in linking the refugees with community activities
Plan for refugees to see a health care worker shortly after arrival
Assist refugees in selecting a family physician, a dentist, etc.
Assist refugees in applying for provincial and Interim Federal Health plans
Enroll children in school (if applicable)
Make child care arrangements (if applicable)
Apply for child tax benefit (if applicable)
IMM 5373A (08-2015) E
(DISPONIBLE EN FRANÇAIS - IMM 5373A F)
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