Census 2011 - 2C

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For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.

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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 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.


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

Introduction statement

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, complete the paper questionnaire today. Census information is important for Canadian communities and is vital for planning services such as schools, daycare, police services and fire protection.

By law, every household must complete a census questionnaire. By the same law, your responses will be kept confidential. To ensure confidentiality, put your completed questionnaire in the envelope provided and seal it. Return your sealed envelope in accordance with instructions from your unit or department. Only Statistics Canada staff will open the sealed envelopes.

Your information may be used by Statistics Canada in support of our other surveys or for analysis.

Thank you for your cooperation.

Reporting instructions

Complete the questionnaire:

- Please print using CAPITAL LETTERS.
- Mark circles with an "X".


STEP A - Question identifier:1.

Do you have a permanent place of residence in Canada presently occupied by one or more members of your family?

  • 1: Yes. What is the exact location of your permanent place of residence?
  • 2: No. What is the address you give for election purposes?

STEP A - Question identifier:2.

Enter the name and address of the military or government establishment OUTSIDE Canada to which you are presently attached or, if none, the city or town and the country in which you reside.

  • 1: Name of establishment
  • 2: Location - City or town
  • 3: Country


STEP B - Question identifier:1.

How many persons usually live at your address (outside Canada) as of May 10, 2011, including yourself?

  • 1: Number of Persons

STEP B - Question identifier:2.

Including yourself, list below all persons who usually live at your address (outside Canada).

  • 1: Family Name, Given Name


Copy the names in Step B to Question 1. Keep the same order. Then answer the following questions for each person.

STEP C - Question identifier:1.


  • 1: Family Name, Given Name

STEP C - Question identifier:2.


  • 1: Male
  • 2: Female

STEP C - Question identifier:3.


  • 1: Day, Month, Year
  • 2: Age

STEP C - Question identifier:4.


  • 1: Never legally married
  • 2: Legally married (and not separated)
  • 3: Separated, but still legally married
  • 4: Divorced
  • 5: Widowed

STEP C - Question identifier:5.

Is this person living with a common-law partner?

  • 1: No
  • 2: Yes

STEP C - Question identifier:6.


  • 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 C - 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 C - Question identifier:8.

(a) What language does this person speak most often at home?

  • 1: English
  • 2: French
  • 3: Other - Specify

(b) Does this person speak any other languages on a regular basis at home?

  • 1: No
  • 2: Yes, English
  • 3: Yes, French
  • 4: Yes, Other - Specify

STEP C - Question identifier:9.

What is the language that this person first learned at home in childhood and still understands?

  • 1: English
  • 2: French
  • 3: Other language - specify:

STEP C - Question identifier:10.

Does this person agree to make his or her 2011 Census information available in 2103 (92 years after the census)?

  • 1: Yes
  • 2: No
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