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Title and description Release Date

Parental contribution (SR-2102A) (PDF, 163 KB)

Form to be completed by parent(s). This form must be completed when a child who is considered a dependent of his or her parents files an application for financial assistance.

July 2019

Qualification Program – Enrolment Application (01-1000) (PDF, 689 KB)

This form is the enrolment application for the following programs:

  • Regulated qualification programs - regulated qualifications
  • Regulated qualification programs - other qualification programs administered by Emploi-Québec
  • Interprovincial Standards Red Seal Program

This guide contains general information to help you complete the enrolment application: Information Guide (PDF, 491 KB)

March 2019

Application for an Administrative Reconsideration (EQ-6505A) (PDF, 96 KB)

Form that must be used to file an application for administrative reconsideration of a decision related to a program, measure or employment service. Used in cases where the decision is not subject to an application for review.

February 2019

Declaration of income (6468A) (PDF, 99 KB)

This form must be completed if you are not receiving public income support. It is required in order to determine whether your income is under the low-income cut-off and will allow the personnel at the Ministère to verify whether you are eligible for financial support in the form of an employment assistance allowance or amount for incidental expenses. Send the duly completed, signed and dated form to your local employment centre (CLE). To find your local employment centre, use the Local Employment Centre LocatorOpens external link in new window..

January 2019

Certificat médical (French only) (SR-0040) (PDF, 266 KB)

Form to be completed by a physician. Required to confirm a pregnancy or health condition that entitles the employment-assistance recipient to a special benefit. Submit the completed form in person or by mail to your local employment center.

October 2018

Avis de placement ou de fin de placement d’un prestataire dans un établissement reconnu par le ministère de la Santé et des Services sociaux (French only) (SR- 0060) (PDF, 1.9 MB)

Form to be completed by a person or organization in the health network that is recognized by the Ministère de la Santé et des Services sociaux (MSSS). Necessary to request the placement of a last-resort financial assistance recipient in an establishment recognized by the MSSS.

Submit the completed form in person or by mail to the local employment centre responsible for the recipient’s file.

By default, Acrobat prints documents in letter format. To print this form on legal size paper (8 1/2 X 14), adjust printing configuration.

October 2018

Proof of residence (SR-2136A) (PDF, 114 KB)

Form required by the local employment centre. This form is intended to provide confirmation, by your landlord or rooming-house keeper, of the information concerning your place of residence.
Submit the completed form in person or by mail to your local employment centre.

October 2018

Medical report (French only) (SR-2100) (PDF, 348 KB)

Form to be completed by a physician. Required to confirm temporary or permanent employment constraints, or the medical needs of a last-resort financial assistance recipient.

Submit the completed form in person or by mail to your local employment centre.

By default, Acrobat prints documents in letter format. To print this form on legal size paper (8 1/2 X 14), adjust printing configuration.

September 2018

Employment services and last resort financial assistance

You must complete the three forms in order to apply for last-resort financial assistance.

If the application is for a couple or a family, each adult must complete the following forms:

However, only one Appendix 2 — Application for Last-Resort Financial Assistance (3003-02A) form needs to be completed per couple or family. Submit the duly completed forms in person or by mail to your nearest local employment centre.

Important: Your eligibility for a last-resort financial assistance program is determined as of the date on which your local employment centre receives the forms.

Before submitting your last-resort financial assistance application, you can obtain a preliminary assessment using the SimulAideOpens external link in new window.. Note, however, that this simulation may not be used for legal interpretation purposes.

Acrobat prints documents in letter format (8½ inches X 11 inches) by default. If you wish to print on legal-size paper (8½ inches X 14 inches or 215 mm by 355 mm), you must select the desired printing format.

August 2018

Administration of Financial Assistance by a Third Party (SR-0014A) (PDF, 294 KB)

Form required to apply to have a third party administer financial assistance granted by virtue of the Individual and Family Assistance Act. Please file the duly completed form in person or by mail with the local employment centre (CLE) responsible for administering the financial assistance recipient’s file. To find your local employment centre, use the Local Employment Centre LocatorOpens external link in new window..

Important: If this is the first time that you have completed this form, we advise you to contact the CLE for information about the application process.

Quick Reference Tool for the Designated Administrator - Social Assistance Program and Social Solidarity Program (PDF, 1.3 MB)

April 2018