Application For Admission
FORM A-1e All fields marked with an asterisk ( * ) are required.
I. PERSONAL INFORMATION
Referred By:
Last Name:* First Name:* Middle:
Street Address:*
City:* State:* Zip Code:* Country:*
Telephone: Sex: Sex Male Female Married? Yes No
Fax: Email:
Employer (Company Name):
Employer Address:
City: State: Zip Code: Country:
Employer Phone:
II. ADMISSION INFORMATION
Have you previously been a student at the U. S. Flight Academy? Yes No *
Date of Graduation: Month: Month January February March April May June July August September October November December Day: Year:
Seeking admission to course (Select desired courses). Hold down the Ctrl key to select more than one course.)*
Recreational Pilot Private Pilot Instrument Rating Commercial Pilot Multi-Enging Rating Airline Transport Pilot CFI - Airplane CFII - Instrument MEI - Multi-Engine Ground Instructor Professional I Course Professional II Course Professional III Course Professional IV Course Professional V Course Professional VI Course
Requested start date: Month: Month January February March April May June July August September October November December Day: Year:*
Second choice: Month: Month January February March April May June July August September October November December Day: Year:*
Physical Record: Date Of Birth: Month: Month January February March April May June July August September October November December Day: Year:*
Place Of Birth: *
Medical Certificate held or statement of general health:*
III. FINANCIAL INFORMATION
Course price for course you are planning to take: $ See Price List. *
How will you finance your training at the U. S. Flight Academy? *
If Other, please specify:
Eligible for Veterans Benefits? Yes No *
Requiring a Student Visa? Yes No *
U. S. Flight Academy is an equal opportunity educator/employer.
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