General Information
Name
(Family / Surname) Last
First
Middle
Note: If you do not have a First or Middle name put XXXX in the box.
Physical Address (Official paperwork will be sent to this address e.g visa paperwork)
Address Line 1:
Address Line 2:
City :
State :
Postal / Zip :
Country :
Telephone (home)  
Telephone (work)  
Telephone (Fax)  
E-mail address  
Country of Birth Country of Citizenship
Date of Birth (Mo/Da/Yr)
City of Birth Weight (lbs) Height (inches) Marital Status
Do you need a Student Visa? Yes
Type of Visa Required
Deposit Placed Yes No Occupation
Emergency Contact Information Name Address and Phone number
Previous Flight Experience (If Any)
Do you currently hold an FAA Pilot Certificate? Yes No
If Yes, please specify the type of certificate and ratings held
Do you currently hold an ICAO Pilot Certificate (other than FAA)? Yes No
If Yes, please specify the licensing country, the type of certificate and ratings held
Do you hold a valid FAA Medical Certificate? Yes No If Yes, please specify: 1st Class 2nd Class 3rd Class
Records of Pilot Time:
  TOTAL  Instruction
Received 		 Solo  Pilot in
Command 		 Second in
Command 		 Cross-
Country
Instruction
Received 		 Cross-
Country
Solo 		 Cross-
Country
Pilot in
Command 		 Instrument  Night
Instruction
Received 		 Night
Takeoffs
and
Landings 		 Night Pilot
in
Command 		 Night
Takeoffs
/Landings
Pilot in
Command 
Airplanes
Rotorcrafts
Total Multi-Engine Flight Time:
Schools attended, locations, programs, dates:
 
Military Background (If Any)
Branch: Rate: Months of Active Duty: Last Day of Duty or E.T.S.:
 
Program Desired
Please specify the type of training program you would like to follow...
Professional Pilot Program (200hr Multi-Engine Course)*
Commercial Pilot Program (NO Instructor ratings)*
VA Individual Courses
100 hours Multi-Engine/Instrument Rating Course
“Twin Time” Program (100 hours of Multi-Engine)
VA Professional Pilot Course		 Individual Course (Please Specify):
      
**A Copy of your High School diploma or GED is MANDATORY if Enrolling in one of our Professional Pilot Courses.**
Date at which you would desire to start your training:
*Required (mm/dd/yyyy)
How did you hear about us?    Internet     Magazine    Friend    Other:
Educational Background
School, State
From (Month/Year)
To Month/Year)
Area of Study
Certificate,
Diploma or
Degree Earned
Copy of Diploma
(Yes/No)*
(*) High School and College Graduates must send a copy of your diploma if you wish to be enrolled in the Pro Course
We Must Receive your Deposit before Application will be Processed