Online Credit Assessment1 Welcome2 Personal Infomation3 Co Applicant4 Income5 Budget6 Assets7 Debts8 Welcome!Thank you for contacting Resolve Credit & Financial CounsellingFor your security, your application must be completed and submitted within 7 days or it will be purged from our system. Please contact us to notify us if you need more time.Our online credit counselling module is a free, convenient and confidential way to get started. You will be asked to enter information about yourself, which will assist us in better understanding how we may be able to help. After we assess the information that you have provided, a certified counsellor will contact you in order to complete the credit counselling session - by phone, e-mail or in person.You will be asked to provide information on the following: 1. Your monthly income (net and gross) 2. Information about your assets 3. List of monthly expenses 4. List of your debtsNOTE: In order for your counsellor to help you, it is important that you supply complete and accurate answers to these questions. If at any time you feel uncomfortable with the process you can contact us and talk to a certified counsellor over the telephone. They will be happy to explain the process and talk you through the assessment form. After you submit your application you may speak with a certified counsellor at any time regarding your personal situation.Disclosure Policy*Welcome to Resolve Credit & Financial Counselling Services, a program of Resolve Counselling Services Canada. We hope that your experience with us will be a rewarding one for you and your family. Our aim is to provide you with quality credit counselling and support during financial hardship. Credit counselling encompasses budgeting, money management, creditor advocacy, exploration of debt solutions & consumer education.Confidentiality Anyone who contacts Resolve Counselling Services Canada is protected by the Personal Information and Protection of Electronic Documents Act (PIPEDA), agency policy and professional ethics, which means that a strict code of confidentiality is maintained. No information about you is released to a third party without your signed consent, except as required by law, as in the case of child abuse or upon clear, concrete evidence of planned or committed acts of violence. Please be aware that email correspondence is not a secure method of communication and may jeopardize confidentiality. Any email correspondence between you and your counsellor that discusses more than simple scheduling issues may be considered part of your client file. Within Resolve, your file may be reviewed in the course of routine management or professional supervision. Your file may also be reviewed for quality assurance purposes by third party auditors or accreditation reviewers.Quality Assurance Resolve Counselling Services Canada is a not-for-profit, charitable organization licensed by the Ministry of Government and Consumer Services. We are a fully accredited member of the Canadian Association of Credit Counselling Services and follow uniform standards of excellence, governance and integrity, including a strong code of ethics. Our Credit Counsellors undergo certification and achieve the designation as an Accredited Financial Counsellor-Canada. This allows them to provide independent, unbiased and professional personal finance expertise to our clients.Client Service Should you not be satisfied with the service you receive here or wish to appeal a decision, please make your concerns known to your Counsellor. If you are not satisfied with the resolution, you have the right to speak with a Credit Counselling Manager. As well, the Director of Credit Counselling is located at our Kingston office, toll-free 1-800-379-5556.Access to Records Client files and the information contained in them are the property of Resolve Counselling Services Canada. You have the right to review your file with your Counsellor or the Credit Counselling Manager. We have a procedure whereby you can request the correction of inaccurate information.Evaluation Your evaluation of our service is important to us. Feel free to make suggestions about how the service can be improved or where it excels. Client feedback helps to ensure we are providing a valuable resource to you. I agree to the Disclosure Policy Personal InformationThis is step 1 of 7. To complete the online assessment all 7 steps must be completed.Personal InformationFirst Name:*Middle Initials:Last Name*Email:* Birth Date:* Date Format: MM slash DD slash YYYY Gender:*-----MaleFemaleEducation:-----CollegeElementary SchoolGraduate SchoolHigh SchoolNot ReportedHow Referred:*-----INTERNAL REFERRALCKWS TVSUN MEDIARADIONATIONAL NETWORK SERVICESNEWSPAPER/MAGAZINEBROCHURESINTERNETBANKSCREDIT UNIONMORTGAGE BROKERCOLLECTION AGENCYSOCIAL SERVICESRELATIVE/FRIENDOACCS/CACCSCOUNSELLED BEFOREBK-BDOSCHOOLROGERS TVEASIER TO READ PHONE BOOKFINANCE COMPANIESADDICTIONS COUNSELLORGAMBLER'S ANONYMOUS/ OLGBK-HARRIS & PARTNERSTRICOLOUR AGENDA-QUEEN'STRANSIT-BACK OF BUSTRANSUNIONTRANSIT-SHELTERDOCTORLAWYER/LEGAL AIDTRANSIT-IN CARMONEYMARTSE.A.P.CHURCHESBIA COUNSELLINGMEDIA APPEARANCETV APPEARANCEAGENCY POSTERYELLOWPAGES-INTERNETTRANSIT ADTV COMMERCIALTV PROGRAMWHITEPAGESYELLOWPAGESBK-CHABOTCOMMUNITY NEWSPAPERSBK-FARBER & PARTNERSOUTDOOR POSTERBK-LAWSON FISHERXTRA! MAGAZINEEMC-SMITH FALLSVOICE MESSAGE RECORDINGHOUSING ALLOWANCE PROGRAMTENANT ASSISTANCE PROGRAMWINTER WARMTH FUNDBETTER BUSINESS BUREAUFINANCIAL PLANNER/INSURANCERADIO ONLINECANADA REVENUE AGENCYBK-WEBB & ASSOCIATESRADIO INTERVIEWSEMINAR/WORKSHOPWORKSHOPWEBINAREMPLOYMENT INSURANCEHOME OWNERSHIPPATHWAYSONTARIO WORKSLANDLORDDOLLARS & SENSEGOOGLE SEARCH ENGINERESOLVE NEWSLETTER211OTHER CCS AGENCYBK-BRIEF & ASSOCIATESTV GUIDE LISTINGSCTVMAGAZINE INTERVIEWLEAPEQUIFAXNEWSPAPER INTERVIEWRESOLVE WEBSITECOMMUNITY SERVICES FAIRBK-MISCELLANEOUSACCOUNTANTBK-DOYLE & SALEWSKIBK-GINSBERG GINGRASPROBATION/PAROLEDNDSIGNAGECHEX TVFACEBOOKKIJIJIONLINE ASSESSMENTBK-GOLDHARGROCERY BAGSBK-MNPCAP CANADACREDITORCOMMUNITY AGENCYEMPLOYERBK-FONTAINE & ASSOCIATESMarital Status:*-----COMMON LAWDIVORCEDMARRIEDSEPARATEDSINGLEWIDOWEDNumber in House Hold:*Housing Status:------OWNRENTOTHERAddress* Address 1 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweCountry PhonePhoneHome Phone:*Work Phone:Cell Phone: Applicant Help Section: -Make sure all contact information is accurate -Use a valid email address you check regularly -Click NEXT to continue to the next section -* denotes required field - you will not be able to proceed until it is filled in Co-applicant InformationPlease provide co-applicant information or you can skip this step if you do not have a co-applicantCo-applicant InformationFirst Name:Middle Initial:Last Name:Maiden Name:Date Of Birth: Date Format: MM slash DD slash YYYY Gender:-----MaleFemaleEducation Level:-----CollegeElementary SchoolGraduate SchoolHigh SchoolNot ReportedMarital Status:-----COMMON LAWDIVORCEDMARRIEDSEPARATEDSINGLEWIDOWEDNumber in House Hold: Co Applicant Help Section: -Fill out this section for your spouse -Maiden name is not required -Click NEXT to continue Monthly Income InformationWhen completing the following MONTHLY income questions, please keep in mind that "MONTHLY Gross Income" is income before any deductions. Your "MONTHLY Net Income" is your take home pay after all deductions have been subtracted. Examples of deductions include taxes, insurance, union dues, RRSP, etc… DO NOT ENTER DOLLAR SIGNS or any other characters, just the dollar amountMonthly Income InformationNet Income (take home/after tax):*Spousal/Child Support:Retirement/Pension:Child Tax Credit:Other Income:Social Assistance:Employment Insurance:Part Time:Name of Employer:Job Title:Pay Period:-----MonthlySemi-monthlyBi-weekly Co Applicant Monthly IncomeCo Applicant Monthly IncomeNet Income (take home/after tax):Spousal/Child Support:Retirement/Pension:Child Tax Credit:Other Income:Social Assistance:Employment Insurance:Part Time:Name of Employer:Job Title:Pay Period:-----MonthlySemi-monthlyBi-weekly Monthly Expense InformationWhen completing the following MONTHLY expense categories, make sure that all fields reflect how much you spend "Monthly". For example, if you estimate that you spend $1,200 a year on clothing your monthly expense would be $100.Monthly Expense InformationGroceriesRent / MortgageProperty Taxes/Condo FeesHydroWaterHeatCar Payment / Transit / TaxisInsurance (Car, Home, Life, etc)GasDaycareSupportOTHER EXPENSESOther-Specify 1 : NameOther-Specify 1 : AmountOther-Specify 2 : NameOther-Specify 2 : AmountOther-Specify 3 : NameOther-Specify 3 : AmountOther-Specify 4 : NameOther-Specify 4 : AmountMonthly Budget Total: Budget Help Section: -Click the SAVE icon to enter your totals -There are multiple sections to fill out for the budget -Please fill out as accurately as possible -Many items may not pertain to your budget - leave them at 0 Asset InformationPlease enter all your asset information.Assets/LiabilitiesPresent ValueAmount OwedPaymentCommentsCash on hand or depositCash on hand or deposit (Present Value)Cash on hand or deposit (Amount Owed)Cash on hand or deposit (Payment)Cash on hand or deposit (Comments)1st Mortgage1st Mortgage (Present Value)1st Mortgage (Amount Owed)1st Mortgage (Payment)1st Mortgage (Comments)2nd Mortgage2nd Mortgage (Present Value)2nd Mortgage (Amount Owed)2nd Mortgage (Payment)2nd Mortgage (Comments)3rd Mortgage3rd Mortgage (Present Value)3rd Mortgage (Amount Owed)3rd Mortgage (Payment)3rd Mortgage (Comment)CottageCottage (Present Value)Cottage (Amount Owed)Cottage (Payment)Cottage (Comments)Household GoodsHousehold Goods (Present Value)Household Goods (Amount Owed)Household Goods (Payment)Household Goods (Comments)Automobile #1Automobile #1 (Present Value)Automobile #1 (Amount Owed)Automobile #1 (Payment)Automobile #1 (Comments)Automobile #2Automobile #2 (Present Value)Automobile #2 (Amount Owed)Automobile #2 (Payment)Automobile #2 (Comments)Boat, Camper, Snowmobile, Camper Trailer, Motorcycle, Tools, etc.Boat, Camper, Snowmobile, Camper Trailer, Motorcycle, Tools, etc. (Present Value)Boat, Camper, Snowmobile, Camper Trailer, Motorcycle, Tools, etc. (Amount Owed)Boat, Camper, Snowmobile, Camper Trailer, Motorcycle, Tools, etc. (Payment)Boat, Camper, Snowmobile, Camper Trailer, Motorcycle, Tools, etc. (Comments)Securities-Bonds, Certificates, Credit Union Shares, Stocks, Etc.Securities-Bonds, Certificates, Credit Union Shares, Stocks, Etc. (Present Value)Securities-Bonds, Certificates, Credit Union Shares, Stocks, Etc. (Amount Owed)Securities-Bonds, Certificates, Credit Union Shares, Stocks, Etc. (Payment)Securities-Bonds, Certificates, Credit Union Shares, Stocks, Etc. (Comments)Life Insurance-Cash Surrender ValueLife Insurance-Cash Surrender Value (Present Value)Life Insurance-Cash Surrender Value (Amount Owed)Life Insurance-Cash Surrender Value (Payment)Life Insurance-Cash Surrender Value (Comments)Registered Retirement or Savings PlansRegistered Retirement or Savings Plans (Present Value)Registered Retirement or Savings Plans (Amount Owed)Registered Retirement or Savings Plans (Payment)Registered Retirement or Savings Plans (Comments)Other-SpecifyOther-Specify (Present Value)Other-Specify (Amount Owed)Other-Specify (Payment)Other-Specify (Comments)Other-SpecifyOther-Specify 2 (Present Value)Other-Specify 2 (Amount Owed)Other-Specify 2 (Payment)Other-Specify 2 (Comments)** (Present Value)* (Amount Owed)* (Payment)* (Comments)** (Present Value)* (Amount Owed)* (Payment)* (Comments)Assets:- Liabilities:= Net Assets: Assets Help Section: -Please fill out to the best of your ability -Leave the ones that don't pertain to you at 0 Debt InformationOn the form below, please enter all of your unsecured creditors’ information. Examples of "Unsecured Creditors" include all credit cards such as MasterCard, Visa, and American Express; retail cards; finance company loans; collection agencies and medical bills.Debt InformationCreditor Name 1:Balance 1:Regular Payment 1:Interest Rate 1:ex: 22.99% enter as .2299Creditor Name 2:Balance 2:Regular Payment 2:Interest Rate 2:ex: 22.99% enter as .2299Creditor Name 3:Balance 3:Regular Payment 3:Interest Rate 3:ex: 22.99% enter as .2299 Debts Help Section: -Do NOT enter account numbers. -Make sure to add all of your unsecured credit card debt in this section -Once you have added them all, click NEXT to continue Additional QuestionsIn this section, you can give us the information about you that has an impact on your financial situation but isn’t in the numbers. The details you share help us get the whole picture. In turn, we are able to provide the help and options which are geared to your issues, goals and expectations. You can also ask questions about your financial situation. All information is kept confidential.Additional QuestionsHow May We Assist You?