2021 Census: 3A

Complete your census questionnaire:

• Please print using CAPITAL LETTERS.
• Mark circles with "X".

Any questions?

• www.census.gc.ca
• Call us free of charge at 1-855-340-2021
• TTY: 1-833-830-3109

Français au verso

Confidential when completed

This information is collected under the authority of the Statistics Act, R.S.C. 1985, c. S-19.

Step A

1. What is your telephone number?

• Number, Ext.

2. What is the address where you received this questionnaire?

• Number (and suffix, if applicable)
  (e.g., 302, 151 B, 16 1/2)
• Street name, street type (e.g., DR = Drive), direction (e.g., N = North)
• Apartment/unit/room
• City, municipality, town, village, Indian reserve
• Province/territory
• Postal code

3. What is the mailing address of this dwelling, if different from above?
(e.g., Rural Route, PO Box, General Delivery)

Step B

1. What is your name?

• Family name(s)
• Given name(s)

Step C

The following questions refer to your situation on May 11, 2021.

If you are:

• a Canadian citizen
  • Continue with step D
• a landed immigrant (permanent resident)
  • Continue with step D
• a person who has claimed refugee status (asylum seeker) in Canada
  • Continue with step D
• a person from another country with a work or study permit
  • Continue with step D

If you are:

• a resident of another country visiting Canada, for example, on vacation or on a business trip
  • Mark "X" the circle
    STOP HERE and see instructions in Step E on page 6.
• a government representative of another country
  • Mark "X" the circle
    STOP HERE and see instructions in Step E on page 6.

Step D

Is this your main residence?

• Yes
  • Continue with question 1 a) on the next page
• No, but I have no other residence in Canada
  • Continue with question 1 a) on the next page
• No, it is somewhere else in Canada
  • Specify complete address
    • Number (and suffix, if applicable)
      (e.g., 302, 151 B, 16 1/2)
    • Street name, street type (e.g., DR = Drive), direction (e.g., N = North)
    • Apartment/unit/room
    • City, municipality, town, village, Indian reserve
    • Province/territory
    • Postal code
    • Telephone number

    STOP HERE.
    You should be included on the household questionnaire for the above address.
    See instructions in Step E on page 6.

1. a) Is there any other address in Canada where someone may include you on the census form for that household?

For example, at the home of a parent, relative or friend, or a place where you live while working, or a vacation home.

• No
  • Go to question 2
• Yes
  • Specify complete address
    • Number (and suffix, if applicable)
      (e.g., 302, 151 B, 16 1/2)
    • Street name, street type (e.g., DR = Drive), direction (e.g., N = North)
    • Apartment/unit
    • City, municipality, town, village, Indian reserve
    • Province/territory
    • Postal code
    • Telephone number

1. b) Please give the name of another adult (if any) living at this other address.

• Family name(s)
• Given name(s)
• No other adult

2. What was your sex at birth?

Sex refers to sex assigned at birth.

• Male
• Female

3. What is your gender?

Refers to current gender which may be different from sex assigned at birth and may be different from what is indicated on legal documents.

• Male
• Female
• Or please specify your gender:

4. What are your date of birth and age?

If exact date of birth is not known, enter best estimate. For children less than 1 year old, enter 0 for age.

• Day
• Month
• Year
• Age

5. What is your marital status?

Mark "x" one circle only.

• Never legally married
• Legally married (and not separated)
• Separated, but still legally married
• Divorced
• Widowed

6. Are you living with a common-law partner?

Common-law refers to two people who live together as a couple but who are not married, regardless of the duration of the relationship.

• Yes
• No

7. What is your status here (at the address you entered on the front cover)?

Mark “x” or specify one response only.

• Resident under care or custody (e.g., patient, inmate)
• Roommate, lodger or boarder
• Employee
• Employee’s family member
• Other status — specify:

8. Can you speak English or French well enough to conduct a conversation?

Mark "x" one circle only.

• English only
• French only
• Both English and French
• Neither English nor French

9. a) What language(s) do you speak on a regular basis at home?

• English
• French
• Other language(s) — specify:

If you indicate only one language in question 9. a), go to question 10.

9. b) Of these languages, which one do you speak most often at home?

Indicate more than one language only if they are spoken equally at home.

• English
• French
• Other language — specify:

10. What is the language that you first learned at home in childhood and still understand?

If you no longer understand the first language learned, indicate the second language learned.

• English
• French
• Other language — specify:

11. Have you ever served in the Canadian military?

Canadian military service includes service with the Regular Force or Primary Reserve Force as an Officer or Non-Commissioned Member. It does not include service with the Cadets (COATS), the Supplementary Reserve or the Canadian Rangers.

Mark "x" one circle only.

• Yes, currently serving in the Regular Force or the Primary Reserve Force
• Yes, but no longer serving in the Regular Force or the Primary Reserve Force
• No

The following questions collect information in accordance with the Canadian Charter of Rights and Freedoms to support education programs in English and French in Canada.

12. Is this dwelling located in Quebec?

• No
  • Continue with question 13.
• Yes
  • Go to question 16.

13. Did you do any of your primary or secondary schooling in French in Canada (including immersion)?

Mark "x" one circle only.

• Yes (previously or currently attending)
• No
  • Go to Step E

14. In which type of program was this schooling in French done?

• A regular French program in a French-language school
• A French immersion program in an English-language school
  • Go to Step E
• Both types of programs
• Other program — specify:

15. For how many years did you attend a regular French program in a French-language school?

• Number of years in primary schooling (including kindergarten and middle school)
  • Number of years
    • Go to Step E
• Number of years in secondary schooling
  • Number of years
    • Go to Step E

16. Did you do any of your primary or secondary schooling in an English-language school in Canada (including immersion)?

Mark "x" one circle only.

• Yes (previously or currently attending)
• No
  • Go to Step E

17. For how many years did you do your schooling in an English-language school in Canada (including immersion)?

• Number of years in primary schooling (including kindergarten)
  • Number of years
• Number of years in secondary schooling
  • Number of years

Step E

You have now completed your questionnaire.

Please see instructions on the envelope.

Thank you for your cooperation.

The law protects what you tell us

The confidentiality of your responses is protected by law. All Statistics Canada employees have taken an oath of secrecy. Your personal information cannot be given to anyone outside Statistics Canada without your consent. This is your right.

Reasons why we ask the questions

Steps A to D and question 1 are used to collect contact information and determine who should be included on the questionnaire. They help us ensure that we have counted everyone we need to count and that no one is counted twice.

Questions 2 to 7 provide information about the living arrangements of people in Canada, the family size, the number of children living with one parent or two parents, and the number of people who live alone. This information is used for planning social programs, such as Old Age Security and the Canada Child Benefit. It is also used by municipalities to plan a variety of services such as day care centres, schools, police, fire protection and residences for seniors.

Questions 8 to 10 are used to provide a profile of the linguistic diversity of Canada's population. This information is used to estimate the need for services in English and French, and to better understand the current state and the evolution of Canada's various language groups.

Question 11 provides information on the number of people with Canadian military experience. Governments will use this information to develop programs and services to meet the changing needs of the Veteran population.

Questions 12 to 17 collect information in accordance with the Canadian Charter of Rights and Freedoms to support education programs in English and French in Canada.

Comments

Please use the space provided below if you have concerns, suggestions or comments to make about:

• the steps to follow or the content of this questionnaire (for example, a question that was difficult to understand or to answer)
• the characteristics of the questionnaire (for example, the design, the format, the size of the text).