Enrollment Application

Primary Applicant Information

* First Name:

* Address 1:

* Last Name:

Address 2:

Middle Initial:

* City:

* Phone #:

* Country:

* Email Address:

* State/Province:

Fax #:

* Zip Code:

* Date of Birth:

Permanent
Mailing Address:

Occupation:

Local Phone:

* Driver's Lic. #:

Cell #:

* Passport #:

Referred By:

* U.S. Citizen: Yes No * U.S. Resident: Yes No

Emergency Contact Information

First Name:

Address 1:

Last Name:

Address 2:

Daytime Phone #:

City:

Evening Phone #:

State

Relationship:

Zip Code:

Country:

For International Students Only

An M-1 Visa is: Required Not Required

If not required, why?

City and Country of Birth:

City and Country of Residence:

Citizen (Name of Country):

Proficiency in English:

Fluent Fair

* All applicants must be able to read, speak and understand English

* Course(s) Requested ( you must make at least one selection )

Private	ATP	Multi Engine
Instrument	CFI-I	Glass Cockpit Transition
Professional Pilot - FAA	CFI	License Conversion
Professional Pilot - DGCA	ME I	King Air C-90 Turbine
Commerical Pilot		Other
Navajo PA-31-350

Preferrred Training Schedule:

FAA Curriculum: Part - 141 Part - 61

* Preferred Start Date:

Preferred End Date:

Please check this box if you must complete training by a specific date

Previous Experience (if applicable)

FAA Certificates / Ratings:

Other Certificates / Ratings:

Issuing Country:

TOTAL FLIGHT
EXPERIENCE

CROSS-COUNTRY

NIGHT

INSTRUMENT

Total
Time

Total
PIC

Total
Dual

Total
Time

Total
PIC

Total
Dual

Total
Time

Total
PIC

Total
Dual

Actual

Sim.

Flight
Sim.

AIRPLANE

HELICOPTER

Accommodation Information

Assistance with accommodation is:

Required Not Required

Name of Hotel:

Date Requested:

Student Loan

Do you currently have a Student Loan? Yes No

Details:

Certification

This will certify that I have reviewed Rick Aviation Flight Training Course, Student Rules and Regulations. I am able to make an informed decision on enrollment in the course I have indicated above. I certify that all of the above statements are true and correct to the best of my knowledge. Course structures are based on FAA minium requirements. Fuel prices subject to change and surcharges may apply.

* (check this box to acknowledge that you have reviewed the information)

Additional Certification for Minors

If the applicant is under the age of 18, the following must be filled in by a parent or legal guardian. The undersigned being a parent or legal guardian of the above applicant, hereby consents to his / her application for admission to Rick Aviation Professional Flight Training.

(Parent or legal guardian check here to give consent to the above applicant)

Name of Parent or Legal Guardian:

Address:

Country:

*Required