General Information
Name
(Family/Surname) Last
First
Middle

Note: If you do not have a First or Middle name put XXXX in the box.


Address
Telephone (home)  
Telephone (work)  
Telephone (Fax)  
E-mail address  
Country of Birth Country of Citizenship
Date of Birth / /
                            Month                     Day                 Year
City of Birth Weight (lbs) Height (inches) Marital Status
Type of Visa Required? M1 ($500.00 Deposit Required) J1 ($1000.00 Deposit Required)
Deposit Drafted? Yes No Occupation
Emergency Contact Information
Name, Address and Phone Number
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):
      
 

Date at which you would desire to start your training: / /
                                                                               Month           Day       Year

Note: You may come to the school before your start date but, NOT after. If you do not make it by your start date you must apply for a new VISA
Educational Background
School, State
From (Month/Year)
To (Month/Year)
Area of Study
Certificate,
Diploma or
Degree Earned
Copy of Diploma
(Yes/No)*
(*) Please attach email or fax copyof your diploma if possible
We Must Receive your Deposit before Application will be Processed