Last Name (Surname / Family Name):
First Name:
Middle Name:
E-mail:
Telephone:
Please call me directly: Yes No
Best time to call me: Morning Evening
Address:
City, State/Province, Postal Code: ,
Country:
Do you require an M1 student visa? Yes No
Date of Birth: (MM/DD/YYYY)
Gender: Male   Female
City of Birth:
Country of Birth:
Country of Citizenship:
Do you hold a current passport: Yes   No
If so, when does your passport expire: (MM/DD/YYYY)
Do you have any dependents coming with you: Yes   No
If yes, list Last name, First name, Middle name,
Suffix, Date of Birth, country of Citizenship,
Gender, Relationship.

This must be done for each dependant:
Click on all courses you wish to
enroll on:

For specific courses or training
requirements & prices not listed please
email fly@aviationpacific.com 		Private
Instrument
Commercial Single
Commercial Multi
Private Multi
Indian DGCA Professional Program(Complete Course)
Professional Program (Complete Course)
Certified Flight Instructor
Certified Flight Instructor Instrument
Multi-Engine Instructor
Hour Building
Desired Start Date: (MM/DD/YYYY)
Can you read and speak English: Yes   No
Are you able to pass an FAA medical exam: Yes   No
Have you ever had an FAA medical exam: Yes   No
Which type of accommodation would you
prefer: 		Hotel   Family Homestay
Please list two emergency contact names,
phone numbers and addresses:
Highest level of education completed:
Do you have any flight time or hold
any flight certificates?
If yes, please list them.
Were you referred to us, if so what
method or by which organization :
ENROLLMENT PAYMENT DETAILS Due to the level of administration needed to enroll a student and issue the appropriate documentation to obtain a study M1 visa (I20) & TSA clearance we now require a $250 deposit. This deposit is non-refundable and must be received no later than 30 days before arrival. (For inclusive programs such as the Professional Program & Indian DGCA Program this deposit will be refunded to the student through the last course payment).