pan am student application studen… · pan am student application 5000 nw 36th street, miami, fl...
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PAN AM STUDENT APPLICATION
5000 NW 36th Street, Miami, FL 33122www.PanAmAcademy.com
PAN AM INTERNATIONAL FLIGHT ACADEMY
305-874 6000
5000 NW 36TH STREET Email Application to: [email protected] MIAMI, FL 33122 Telephone (305) 874-6000 Fax: (305) 874-6612
Name of Applicant (Please print): Must be written as it appears on your passport Last:_____________________________First:_______________________________Middle:_______________________________
Present Address:
Street & Number_________________________________________________City_______________________________________
State / Province __________________________ Country: ________________ Postal code______________________________
Telephone (include country code)____________________________ EMAIL:_________________________________________
Emergency Contact (Please print):
Last:_____________________________First:_______________________________Middle:_______________________________
Emergency Contact Address:
Street & Number_________________________________________________City_______________________________________
State / Province __________________________ Country: ________________ Postal code______________________________
Emergency Telephone (include country code)_________________________________________________________________
EMAIL ADDRESS:__________________________________________________________________________________________
Personal Information:
Gender:______ Male:______ Female Height:______ Cm / Inch Weight:______ (Kilos /Lbs) Eyes:_____________________
Hair: ________________________ Place of Birth______________________________ Date of Birth:______/ _____/ ________ MONTH DAY YEAR
Marital Status: ________ Single ________ Married Current Occupation: __________________________________________
Passport Number:_____________________________ Country of Citizenship:______________________________________
Drivers License (If applicable) __________________________________ Country: ____________________________________
Drug / Alcohol Conviction within the past 12 months: ________Yes _________No
SCHOOL RECORDSList the three most recent schools attended (High School, University, and Technical)
Student Housing Required? ______Yes _____No Do you Smoke? _____Yes _____ No
FLIGHT EXPERIENCE (If Applicable):
List all Flight Certificates held:________________________________________________________________________________
Name of School where ratings were obtained: _________________________________________________________________
FAA Medical:_________None _______1st Class _______ 2nd Class _______ 3rd Class Date of Issue: _________________
PILOT TIME
COURSE FEE:______________________ DEPOSIT: _____________________ DATEPAID: __________________________
Sales/Account Executive: ____________________________________Planned Start Date: _____________________________
FLIGHT COURSE REQUIRED
5000 NW 36th Street, Miami, FL 33122www.PanAmAcademy.com
PAN AM INTERNATIONAL FLIGHT ACADEMY
305-874 6000
SCHOOL LOCATION DATES ATTENDED DIPLOMA / DEGREE
FROM -------------- / -----------TO----------- / -------------
FROM -------------- / -----------TO----------- / -------------
FROM -------------- / -----------TO----------- / -------------
TOTAL CROSS COUNTRY INSTRUMENT NIGHT COMPLEX SIMULATOR
SOLO
DUAL
_____ PROFESSIONAL PILOT PROGRAM (AB INITIO)
_____ TYPE RATING (PIC Initial) EQUIPMENT _________ Specify (B737, B777, A320, etc)
_____ FLIGHT ATTENDANT TRAINING
_____ * PRIVATE
_____ * COMMERCIAL
_____ * INSTRUMENT
_____ * MULTI-ENGINE
_____ CFI _____ CFI II
_____ CFI ME _____ ATP _____ JET TRANSITION
No previous experience required. This course combines the private, commercial, instrument and multiengine courses marked with an asterisk (*)
_____ AIRCRAFT DISPATCHER TRAINING _____ AB INITIO (200 HOURS)
_____ ADVANCED (80 HOURS)
_____ AIR TRAFFIC CONTROLLER _____ AB INITIO ______ RECURRENT
APPLICATION AGREEMENT
1. Please fill out this form entirely.2. Attach a clear photocopy of a valid Passport, (if applicable attach license and visa)3. Attach a bank statement demonstrating that you or your sponsors have the financial resources required for your education in the US. (funds shown should reflect flight course tuition)4. Upon receipt of the above via e-mail, an I-20 form and acceptance letter will be sent to you (applicant). You will then be able to proceed to a US Consulate or Embassy in your country to request an M-1 visa.5. Upon arrival to Pan Am International Flight Academy, students are enrolled according to the requirements of the training center, the course purchased and US Government regulations.6. Before arrival, a deposit equal to 50% of the estimated tuition cost is required prior to starting the Program. The remaining balance of 50% must be paid at arrival to Pan Am International Flight Academy. (A minimum $2,500 deposit must be made prior to Scheduling a class)7. Student accepts that they have clearly read their sales agreement and fully understand all elements of the training they are purchasing.
Signature Approval of Applicant:
I apply for admission to the course(s) indicated, and accept the above terms and conditions.
Student Signature:______________________________________________________________ Date: ______ / ______ / ______ MON DAY YEAR
Parent / Guardian Sponsors
Where the students are under the authority of parents, guardians, etc., the responsible authority must sign here: I accept the above terms and conditions:
Parent / Guardian Signature:_________________________________________________________________________________
Date: ______ / ______ / ______ MONTH DAY YEAR
Relationship to student:_____________________________________________________________________________________
Parent / guardian Telephone (Include country code): ___________________________________________________________
Parent / guardian Address:
Street & Number___________________________________________________________ City:___________________________
State / Province: __________________________ Postal Code / Zip___________________ Country: ______________________
5000 NW 36th Street, Miami, FL 33122www.PanAmAcademy.com
PAN AM INTERNATIONAL FLIGHT ACADEMY
305-874 6000