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ECA Report Request Form PDF

The document is a request form for pharmacists seeking an Educational Credential Assessment (ECA) report from the Pharmacy Examining Board of Canada (PEBC) to support their application for Canada's Federal Skilled Worker Program. The ECA report confirms the authenticity of the applicant's pharmacy credentials and verifies that their degree is comparable to a Canadian pharmacy degree. Applicants must have already undergone a credential evaluation by PEBC and agree to terms including PEBC sharing their personal information with Citizenship and Immigration Canada.

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2K views2 pages

ECA Report Request Form PDF

The document is a request form for pharmacists seeking an Educational Credential Assessment (ECA) report from the Pharmacy Examining Board of Canada (PEBC) to support their application for Canada's Federal Skilled Worker Program. The ECA report confirms the authenticity of the applicant's pharmacy credentials and verifies that their degree is comparable to a Canadian pharmacy degree. Applicants must have already undergone a credential evaluation by PEBC and agree to terms including PEBC sharing their personal information with Citizenship and Immigration Canada.

Uploaded by

Afza Akbar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Pharmacist Educational Credential Assessment (ECA) Report for

Canada’s Federal Skilled Worker Program

REQUEST FORM

All information must be clearly printed or typewritten (other than signatures)


The Pharmacy Examining Board of Canada (PEBC) is authorized by Citizenship and Immigration Canada (CIC) to
provide Educational Credential Assessments (ECA) for Principal Applicants intending to apply under the Federal
Skilled Worker Program (FSWP) and for whom Pharmacist would be the primary occupation for their application to
immigrate to Canada. The ECA Report issued by PEBC will confirm the authenticity of the candidate’s credential
and whether the candidate’s pharmacy degree is comparable to a CCAPP Canadian pharmacy degree. To request
an ECA Report, pharmacists must have previously submitted their educational documents to PEBC for Pharmacist
Document Evaluation.
PEBC ID Number (if previously assigned) Salutation
□ Ms. □ Miss □ Mrs. □ Mr.
Surname/Family Name*

First Name/Given Name(s)*

Date of Birth (dd/mm/yyyy)* Email*

The ECA Report should be sent to the above-named individual at the following address:
Street Number and Name*

City* Province/State

Country* Postal/Zip Code*

I, the undersigned, acknowledge that:


I understand that my ECA Report can only be processed after Pharmacist Document Evaluation has been
completed. If my Document Evaluation is still in progress, the processing of my request will take place when
Document Evaluation is completed.
I understand that PEBC will not send my ECA Report to CIC because CIC only accepts original assessments
directly from applicants. PEBC will provide me with an original ECA Report so that I can submit it to CIC.
I have READ, UNDERSTAND and AGREE to the ECA Report Terms and Conditions outlined on page 2 of this
request form, as evidenced by my signature on page 2 in the presence of a witness. I understand that PEBC will
share an electronic version of my ECA Report with CIC.

Signature* Date (dd/mm/yyyy)*

* Required

Please mail the complete form (both pages) to: The Pharmacy Examining Board of Canada, 717 Church
Street, Toronto, ON, M4W 2M4.
The Pharmacy Examining Board of Canada (PEBC) Terms and Conditions for the Educational
Credential Assessment (ECA) Report

All applicants submitting a request for an ECA Report are required to accept these PEBC Terms and Conditions as part of
the process of submitting a request.

Background:
I intend to apply to Citizenship and Immigration Canada (CIC) as a pharmacist under the Federal Skilled Worker Program
(FSWP) and, in connection with my application, I hereby request the preparation of an ECA Report. I understand that PEBC
is authorized by CIC to provide an educational credential assessment for pharmacist applicants to the FSWP. I acknowledge
and agree that PEBC shall have no legal liability for the review and that PEBC is not responsible for any decisions made by
CIC regarding my FSWP application.

Authority to Collect Personal Information:


I understand that my personal information is being collected for the purpose of obtaining an ECA Report for immigration
purposes, as authorized by CIC. PEBC does not collect this information on behalf of CIC. I hereby authorize PEBC to share
my personal information, ECA Report and enclosed documents with CIC for the purpose of the FSWP requirements. I
understand that the information shared by PEBC with CIC will be stored in Personal Information Banks (PPU 042 entitled
Immigrant Case File and PPU 053 entitled Permanent Resident Data System). The information may be shared with other
Canadian government institutions such as the Canada Border Services Agency (CBSA), the Royal Canadian Mounted Police
(RCMP), the Canadian Security Intelligence Service (CSIS), and foreign governments in accordance with subsection 8(2) of
the Privacy Act. It may also be disclosed to foreign governments, law enforcement bodies and detaining authorities with
respect to the administration and enforcement of immigration legislation where such sharing of information may not put the
individual and or his/her family at risk. Information may also be systematically validated by other Canadian government
institutions under the terms of an agreement or arrangement for the purposes of validating status and identity to administer
their programs. Under the provisions of the Privacy Act and the Access to Information Act, individuals have the right to
protection of and access to their personal information. Details on these matters are available at the Infosource website
(http://infosource.gc.ca) and are also available at public libraries across Canada.

Consent to Share and Retain ECA Report:


Upon completion of the ECA Report by PEBC, I authorize PEBC to provide CIC with electronic access to my ECA Report
and other information. I authorize PEBC to provide my ECA Report to the third party(ies) that I have identified. I request that
PEBC retain my educational credential records and ECA Report indefinitely.

Release of Liability:
I hereby forever irrevocably release, discharge, remise, indemnify and hold harmless PEBC, its members, directors, officers,
employees, agents, volunteers, contractors and any of them, and each of their respective successors, heirs, executors,
administrators and assigns, from any and all liability for any loss, damage, injury or expense (including legal fees and
expenses) that I may suffer as a result of, or in respect of the preparation by PEBC of any ECA Reports about me, of the
disclosure of any ECA Reports about me to CIC, of the failure by PEBC to provide any ECA Report about me and from any
other acts, communications, other reports, records, diplomas, transcripts, statements, documents, recommendations or
disclosures by PEBC involving me, both now and in the future. Without limiting the generality of the foregoing, I understand
that there may be circumstances beyond PEBC’s control which limit or make impossible the provision of an ECA Report,
including, without limitation, conditions in a particular source country. In such circumstances, PEBC may not be able to
provide an ECA Report. I acknowledge and agree that PEBC will have no liability to me in connection with any inability or
failure of PEBC to provide an ECA Report.

Amending These Terms and Conditions:


I understand that PEBC has the right to unilaterally amend these ECA Report Terms and Conditions from time to time.

Acknowledgement and Certification:


I acknowledge that I have read and understand these ECA Report Terms and Conditions and the applicable policies
referenced herein and agree to abide by them. I hereby certify that I am the person referred to in my ECA Report Request
Form and in all documents and credentials submitted, referenced or relied upon as part of my application and that all
statements I have made or shall make on or in connection with the ECA Report Request Form are true and correct. These
ECA Report Terms and Conditions are binding upon my successors, heirs, executors, administrators and assigns.

Signed this _____________ day of _____________________, 2________

________________________________________ ___________________________________________
NAME OF APPLICANT (please print) NAME OF WITNESS (please print)

________________________________________ ____________________________________________
SIGNATURE OF APPLICANT SIGNATURE OF WITNESS

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