Section I: PERSONAL AND CONTACT INFORMATION You must enter your name above exactly as it appears on official government-issued IDs such as passport, birth certificate, etc. Select School Location Philadelphia, PAPompano Beach, FL First Name * Middle Initial Last Name * Suffix Street Address City State Postal Code Country Home Phone Cell Phone * Work Phone E-mail * Driver's License State Country Exp. Date MM/DD/YYYY / / Date of Birth MM/DD/YYYY / / Gender MaleFemale Birth City Birth State Birth Country Emergency Contact Contact Relationship Emergency Contact Phone Local Address (where are you staying?) City State Postal Code Country Height in Inches Weight in Pounds Hair Color Eye Color Section II: SECURITY AND PRIVACY Important! US citizens will be required to show proof of citizenship upon arrival. Non-US citizens are required to obtain the proper TSA security clearance(s) with a “Permission to Initiate Training” status prior to starting a flight training course. Non-US citizens must obtain a TSA category III security clearance prior to starting flight training. Country of Citizenship Passport Number Issue Date MM/DD/YYYY / / Exp. Date MM/DD/YYYY / / Section III: AERONAUTICAL EXPERIENCE DATA Fill out this section if you are already a certified pilot applying for flight training for advanced rating. If you are a student pilot with previous training and flight time, then please complete any and all appropriate information in this section. If you are applying for a Private Pilot training course and are starting from the beginning and do not yet have a medical certificate, then you may skip to the next section. Do You Now Hold a US Pilot Certificate? YesNo FAA (US) Pilot Certificate Number Ratings FAA (US) Medical Certificate Number Class Issued MM/DD/YYYY / / Non-US (ICAO) Pilot Certificate and Ratings Total Flight Hours Date of Last Flight MM/DD/YYYY / / Last Flight Review MM/DD/YYYY / / High Performance Endorsement? Complex Aircraft? Tailwheel? Hours Flown as Pilot in Command in the Last... Last 2 Months Last 6 Months Last 12 Months Please note! Applicants for advanced rating training courses should read FAR part 61 for the required aeronautical experience for the rating desired before submitting this application. Section IV: ENGLISH PROFICIENCY STATEMENT I understand that the Federal Aviation Administration (FAA) requires that all pilot applicants be able to read, write, speak and understand the English language and that my English skills must meet or exceed the FAA and ICAO minimum requirements. I also understand that if English is my second language, my flight training course may take longer than the advertised length of time for training. Section V: HOW DID YOU HEAR ABOUT FLY LEGACY AVIATION Fill out this section if you are already a certified pilot applying for flight training for advanced rating. If you are a student pilot with previous training and flight time, then please complete any and all appropriate information in this section. If you are applying for a Private Pilot training course and are starting from the beginning and do not yet have a medical certificate, then you may skip to the next section. AdvertisingGoogle SearchFriends/Students Sign OutsideEducational AgentsReferral Name $500.00 The cost of enrollment is a non-refundable $500 processing fee. By submitting this application, I agree to the Terms & Policies of Fly Legacy Aviation. Δ
