For Information only This is an electronic survey example for information purposes only. This is not a working questionnaire.
The census is designed to provide information about the demographic and social characteristics of the people living in Canada and the housing/dwelling units they occupy.
This information is collected under the authority of the Statistics Act, R.S.C. 1985, c. S-19, and must be provided by law.
Confidential when completed
THE LAW PROTECTS WHAT YOU TELL US
The confidentiality of your census responses is protected by law. All Statistics Canada employees have taken an oath of secrecy. Your personal census information cannot be given to anyone outside Statistics Canada without your consent. This is your right.
Your census information will be retained in accordance with legislative requirements and will be stored securely. You can ask to see the information about yourself on your 2011 Census questionnaire after November 2011. To do this, write the Privacy Coordinator, Statistics Canada, 25th Floor, R.H. Coats Building, Ottawa, Ontario K1A 0T6.
REASONS WHY WE ASK THE QUESTIONS
Steps A and B, and Question 1 are asked to determine who should complete this questionnaire. Questions 2 to 6 are asked to learn about the living arrangements of people living in Canada. This information is used for planning social programs, such as Old Age Security and the Canada Child Tax Benefit. It is also used by towns and cities to plan a variety of services such as day care centres, schools, police and fire protection. Questions 7, 8 and 9 provide information to determine the need for language services in English and French according to the Official Languages Act, and are used to implement programs that protect the rights of Canadians under the Canadian Charter of Rights and Freedoms. Question 10 provides each person with the opportunity to make an informed decision about what happens to his or her personal census information in 92 years.
- www.census2011.gc.ca - Call us free of charge 1-877-777-2011 - TTY users call 1-866-753-7083
Ce questionnaire est disponible en français 1-877-777-2011
Message from the Chief Statistician of Canada
The census has always provided a portrait of our people and the places in which we live. The 2011 Census will continue this tradition.
To be part of this new portrait of Canada, please complete your census questionnaire within the next 10 days. To complete it online use the website and the secure access code or, alternatively, complete and return the paper version.
By law, every household must complete a census questionnaire. By the same law, your responses will be kept confidential. Census information is important for your community and is vital for planning services such as schools, daycare, police services and fire protection.
Your information may be used by Statistics Canada in support of our other surveys or for analysis.
Thank you for your cooperation.
Complete your Census questionnaire:
- ONLINE at www.census2011.gc.ca by using the secure access code. OR - ON PAPER, please print using CAPITAL LETTERS.
STEP A - Question identifier:1.
Print your telephone number
1: Area Code, Telephone Number
STEP A - Question identifier:2.
Complete this section if there is no printed address on the front page or if the printed address does not correspond to this dwelling
1: No. and street or lot and concession
2: Apt. no
3: City, municipality, town, village, Indian reserve
5: Postal code
STEP B - Question identifier:1.
How many persons usually live at this address on May 10, 2011, including yourself?
1: Number of Persons
STEP B - Question identifier:2.
Including yourself, list below all persons who usually live here.
1: Family Name, Given Name
Did you leave anyone out of Step B because you were not sure the person should be listed? (For example, a person living at this address who has another home, a person temporarily away, etc.)
2: Yes. Specify the name, the relationship and the reason.
STEP D - Question identifier:1.
Is anyone listed in Step B a farm operator who produces at least one agricultural product intended for sale? Crops, livestock, milk, poultry, eggs, greenhouse or nursery products, Christmas trees, sod, honey, bees, maple syrup products, furs, etc.
1: No. Go to Step E.
STEP D - Question identifier:2.
Does this farm operator make the day-to-day management decisions related to the farm?
Copy the names in Step B to Question 1. Keep the same order. Then answer the following questions for each person.
STEP E - Question identifier:1.
1: Family Name, Given Name
STEP E - Question identifier:2.
STEP E - Question identifier:3.
DATE OF BIRTH AND AGE
1: Day, Month, Year
STEP E - Question identifier:4.
1: Never legally married
2: Legally married (and not separated)
3: Separated, but still legally married
STEP E - Question identifier:5.
Is this person living with a common-law partner?
STEP E - Question identifier:6.
RELATIONSHIP TO PERSON 1
1: PERSON 1
2: Opposite-sex husband or wife of Person 1
3: Opposite-sex common-law partner of Person 1
4: Same-sex married spouse of Person 1
5: Same-sex common-law partner of Person 1
6: Son or daughter of Person 1 only
7: Son-in-law or daughter-in-law of Person 1
8: Grandchild of Person 1
9: Father or mother of Person 1
10: Father-in-law or mother-in-law of Person 1
11: Brother or sister of Person 1
12: Son or daughter of both Persons 1 and 2
13: Son or daughter of Person 2 only
14: Foster child
15: Room-mate, lodger or boarder
16: Other - Specify
STEP E - Question identifier:7.
Can this person speak English or French well enough to conduct a conversation?
1: English only
2: French only
3: Both English and French
4: Neither English nor French
STEP E - Question identifier:8.
(a) What language does this person speak most often at home?
3: Other - Specify
(b) Does this person speak any other languages on a regular basis at home?
2: Yes, English
3: Yes, French
4: Yes, Other - Specify
STEP E - Question identifier:9.
What is the language that this person first learned at home in childhood and still understands?
3: Other language - specify:
STEP E - Question identifier:10.
Does this person agree to make his or her 2011 Census information available in 2103 (92 years after the census)?