PAGE 1
(DISPONIBLE EN FRANÇAIS - IMM 0167 F) Save Reset Form Print Form Page of SPONSORSHIP AGREEMENT HOLDER (SAH) ORGANIZATIONAL ASSESSMENT Information requested in this form is required by Immigration, Refugees and Citizenship Canada (IRCC) to make a decision on the renewal of your SAH’s Sponsorship Agreement and to identify your SAH’s relative operating risks in order to assign a Risk Management Plan. Before you complete the form, read the Organizational Assessment Application Guide IMM0166 PART I: ORGANIZATION PROFILE 1. SAH ORGANIZATION INFORMATION NAME OF SAH: SAH PRIMARY MAILING ADDRESS Apt/Unit Street no. Street name CITY: PROVINCE: POSTAL CODE: SAH PRIMARY PHONE NUMBER: SAH PRIMARY E-MAIL ADDRESS: SAH WEBSITE: 1.1 FINANCIAL STATEMENTS HAVE FINANCIAL STATEMENTS BEEN INCLUDED? Yes No ARE THE STATEMENTS DATED WITHIN THE LAST 18 MONTHS? Yes No HAVE THE STATEMENTS BEEN AUDITED BY A CHARTERED PROFESSIONAL ACCOUNTANT (CPA)? Yes No 1.2 ARTICLES OF INCORPORATION HAS YOUR ORGANIZATION BEEN INCORPORATED FOR AT LEAST TWO YEARS? Yes No Note: Include a copy of the Articles of Incorporation with your completed Assessment Form 2. INFORMATION ON THE SAH PRESIDENT/CHAIR OR CHIEF EXECUTIVE OFFICER/EXECUTIVE DIRECTOR NAME: POSITION TITLE: E-MAIL ADDRESS: PHONE NUMBER: 2.1 BACKGROUND CHECK HAVE THE FOLLOWING DOCUMENTS BEEN INCLUDED FOR THIS INDIVIDUAL? Proof of Canadian Citizenship, Registered Indian Status or Permanent Resident (PR) status Yes No Criminal record check (non-vulnerable sector) issued within last 6 months Yes No 3. INFORMATION ON SAH MAIN CONTACT NAME: POSITION TITLE: E-MAIL ADDRESS: PHONE NUMBER:

PAGE 2
Page of Save Reset Form Print Form 3.1 BACKGROUND CHECK HAVE THE FOLLOWING DOCUMENTS BEEN INCLUDED FOR THIS INDIVIDUAL? Proof of Canadian Citizenship, Registered Indian Status or Permanent Resident (PR) status Yes No Criminal record check (non-vulnerable sector) issued within last 6 months Yes No 3.2 TRAINING HAS THIS INDIVIDUAL COMPLETED THE MANDATORY SAH RENEWAL TRAINING PROVIDED THROUGH THE REFUGEE SPONSORSHIP TRAINING PROGRAM (RSTP)? Yes No Note: Include a copy of the Training Certificate with your completed Assessment Form or by the identified due date. 4. INFORMATION FOR EACH PERSON WHO HAS SIGNING AUTHORITY TO SUBMIT SPONSORSHIP APPLICATIONS NAME: POSITION TITLE: E-MAIL ADDRESS: PHONE NUMBER: 4.1 BACKGROUND CHECK HAVE THE FOLLOWING DOCUMENTS BEEN INCLUDED FOR THIS INDIVIDUAL? Proof of Canadian Citizenship, Registered Indian Status or PR status Yes No Criminal record check (non-vulnerable sector) issued within last 6 months Yes No 4.2 TRAINING HAS THIS INDIVIDUAL COMPLETED THE MANDATORY SAH RENEWAL TRAINING PROVIDED THROUGH THE REFUGEE SPONSORSHIP TRAINING PROGRAM (RSTP)? Yes No Note: Include a copy of the Training Certificate with your completed Assessment Form or by the identified due date. + - PART II – OPERATING RISK ANALYSIS ORGANIZATIONAL STRUCTURE & CAPACITY Organizational structure 5. Provide a description of your organization’s structure (formal and informal). Include in your response the following points: • How is your organization governed? • How is the Board of Directors and any committees structured? • How are the board members selected? • What is the reporting relationship of staff to the board? 6. Provide details about your organization’s existing formal and informal oversight practices. Include in your response the following points: • What type of oversight (both formal and informal) does your organization conduct? • What mechanisms are in place to ensure accountability? 7. How does your organization exercise due diligence in screening SAH staff and volunteers involved with the settlement of refugees?

PAGE 3
Page of Save Reset Form Print Form 8. What formal or informal processes are in place to provide support, training and information-sharing for SAH staff and volunteers involved with the settlement of refugees? 9. What formal or informal processes are in place for planning succession and continuity? Staffing Resources 10. Demonstrate that your SAH has sufficient staffing resources and capacity to support your SAH sponsorship workload. Include in your response the following information: • The number of full-time equivalents (FTEs) devoted to your organization’s SAH sponsorship work (including both paid staff and SAH volunteers): Paid Staff FTEs: SAH volunteer FTEs: • Describe the roles and responsibilities of all SAH personnel (paid or volunteer) in supporting sponsorship activities under each of the following general categories, where applicable. Under each category, list the general activities performed, the SAH personnel responsible for each activity, and the overall estimated percentage of staff time devoted to each of the activities. Administrative activities: Case Selection and application preparation/submission: Assessment and training of Constituent Groups (CGs) and Co-sponsors: Direct provision of post-arrival supports for newcomers: Post-arrival monitoring: Work involved in preparing for and supporting higher needs cases (e.g. Joint Assistance Sponsorship (JAS) cases), if applicable OTHER (please indicate), if applicable: + - 11. If your SAH depends on resources of Constituent Groups, co-sponsors, or informal partners (family or community members that provide support but are not parties to the sponsorship), explain their general roles and responsibilities in relation to those of the SAH as detailed in the previous question. Geographic Oversight & Coordination 12. Does your SAH coordinate sponsorships between Constituent Groups, co-sponsors, appointed representatives, and/or informal sponsorship partners in more than one community of settlement, province, or territory? Yes No 13. What geographic areas do you operate in? 14. How does your SAH manage/distribute the workload across all areas it serves?

PAGE 4
Page of Save Reset Form Print Form 15. Provide details about formal and informal mechanisms that are in place to provide support, training and information-sharing for all parties in each geographic area your SAH serves. 16. Provide details about existing oversight policies and practices in place to conduct coordination and monitoring of the sponsorship activities in different areas your SAH serves. FINANCIAL & SETTLEMENT CAPACITY & CONTINGENCY PLANNING Ongoing Availability of Financial Resources 17. What mechanisms are in place to ensure that your SAH has sufficient financial capacity to meet its sponsorship obligations? 18. What are the main sources of funding for your SAH’s sponsorship obligations? 19. How do you ensure that your SAH’s source of sponsorship funding is sustainable? Policies & Procedures for Funds not held by SAHs 20. Who holds the funds for your sponsorships - your organization as the SAH, Constituent Groups, co-sponsors, informal partners, or a combination? 21. What practices and reporting structures are in place for any funds the SAH does not hold (i.e., funds held by a co-sponsor or Constituent Group or informal partner)? Contingency Planning 22. What is your SAH’s contingency plan to ensure that required resources will be available in the event that any party to the sponsorship becomes unable or unwilling to meet their financial and settlement obligations to the sponsored refugees, either prior to the arrival of the refugees or over the duration of the sponsorship period? Provision of Settlement Supports 23. What formal or informal practices are in place to ensure that required settlement supports and services will be provided to the newcomer? Include in your response the following information: • How do you ensure sponsors are aware of services they are required to provide to the newcomer (transportation, interpretation, housing, school registrations, childcare, etc.)? • Considering that the process for sponsorship takes time, what systems are in place to ensure your groups remain available and ready to receive sponsored refugees? • How to you ensure that connections are made to services and supports available through Service Provider organizations, community services, and essential federal/provincial programs in the community of settlement? 24. If resettlement is planned for remote or rural areas, how will your organization ensure supports are provided? 25. If partnering with co-sponsor or CGs, how does the SAH define roles and responsibilities of each party and prepare for and monitor provisions of settlement supports?

PAGE 5
Page of Save Reset Form Print Form ORGANIZATIONAL OVERSIGHT OF SPONSORSHIP PARTIES & CASES Screening of CGs and Co-sponsors 26. Does your SAH formally partner with Constituent Groups or co-sponsors? YES, the SAH partners with Constituent Groups or co-sponsors for some or all sponsorships NO, the SAH sponsors directly and does not formally partner with Constituent Groups or co-sponsors 27. Explain your organization’s process for determining whether or not to work with potential sponsorship partners (CGs and/or co-sponsors). Include in your response the following points: • What criteria is used to screen or assess partners? • How does your SAH ensure that potential partners have sufficient financial resources for sponsorship? • Does your organization give any consideration to potential partners’ previous sponsorship experience? Provision of Information and Support to CGs & Co-sponsors 28. Explain how your organization ensures that CGs and co-sponsors have ongoing information and support to meet the responsibilities of the sponsorship undertaking. Include in your response the following points: • What is your organization’s training plan when working with partners? • Do you provide in-house/direct training/support to partners? • Do you utilize any external training referrals for partners (e.g. RSTP training) • What is your training schedule? • How, when, and how often is information, assistance and support provided by the SAH? • What other resources does the SAH use (e.g. RSTP)? Monitoring CGs & Co-sponsors 29. Provide details on how your SAH will monitor its CGs and co-sponsors over the duration of the sponsorship period to ensure they are meeting responsibilities of the Sponsorship Undertaking. Include in your response the following points: • Planned method and frequency of oversight and monitoring activities • Is the method different based on the community of settlement of newcomers (e.g. cases in the SAH’s community versus those who settle in other communities, including other provinces)? 30. How does your SAH handle any identified concerns related to CGs or co-sponsors not fulfilling their obligations under the Sponsorship Undertaking? Working with Informal Partners 31. If applicable, explain how your SAH plans to work with any informal partners involved in the provision of support to sponsored refugees. This may include family or community members that are not formally recognized as parties to the sponsorship and are not reflected on the Sponsorship Undertaking, but who play a role in supporting newcomers. Include in your response the following information: • the division of responsibility between any informal partners and the formally recognized parties to the sponsorship • any oversight and accountability mechanisms in place (both formal and informal) to coordinate activities and ensure that supports are being provided

PAGE 6
Page of Save Reset Form Print Form 32. If applicable, how does your SAH plan to handle any identified concerns related to provision of financial or settlement supports by informal partners? Monitoring Sponsored Cases 33. Explain how your SAH will monitor its sponsored caseload over the duration of the sponsorship period to ensure newcomers are being adequately supported post-arrival. Include in your response the following points: • Planned method and frequency of monitoring activities • how the information collected is used • Is the method different based on the community of settlement of newcomers (e.g. cases in the SAH’s community, and those who settle in other communities, including other provinces)? • Does the newcomer have a known avenue for bringing forward concerns? 34. How does your SAH plan to handle any identified concerns related to provision of required financial or settlement supports? DECLARATION & SIGNATURE I declare that the information provided is, to the best of my knowledge, complete and accurate. Name of SAH Representative who has Completed this Template Surname Given Name(s) Name and Signature of SAH Representative who has Signing Authority to submit sponsorship Applications: Surname Given Name(s) Signature Date PRIVACY NOTICE: The information you provided on this form is collected under the authority of the Immigration and Refugee Protection Act and will be used to make an administrative decision on the renewal of your organization’s Sponsorship Agreement Holder (SAH) Agreement and to conduct an Operating Risk Assessment. The information may be shared with other Canadian government organizations, such as the Canada Border services Agency (CBSA), the Royal Canadian Mounted Police (RCMP), the Canadian Security Intelligence Service (CSIS) as a consistent use of information in accordance with subsection 8 (2) of the Privacy Act. Information may be systematically validated by other Canadian government institutions in order to administer the Private Sponsorship of Refugees (PSR) program. Information may also be shared with the Refugee Sponsorship Training Program (RSTP) and the Sponsorship Agreement Holders Association, in accordance with the consistent use of information under the Privacy Act. Failure to complete the form in full may result in the application not being processed. The Privacy Act gives individuals the right of access to, protection, and correction of their personal information. If you are not satisfied with the manner in which IRCC handles your personal information, you may exercise your right to file a complaint to the Office of the Privacy Commissioner of Canada. The collection, use, disclosure and retention of your personal information is further described in IRCC’s Personal Information Bank – IRCC PPU 008. Details on these matters are available at Infosource and through the Immigration, Refugees and Citizenship Canada Call Centre. Infosource is also available at Public Libraries in Canada.