Journeys Aviation™ Application

Personal Information

First Name*

Last Name*

E-mail*

Please Re-enter your
E-mail address*

Telephone Number*

Sex

M F

Marital Status

Citizenship

Permanent Address*

City*

State / Province*

Zip / Postal Code*

Country*

Local Address

City

State / Province

Zip / Postal Code

Country

When would you like to start training?*

Less than 2 months
3 to 6 months
7 or more months

Course Information

Please select the Course(s) that you are applying for:

F.A.R. Part 141 Courses
Private Course	Instrument Course	Commercial Course
CFI Course	CFII Course	MEI Course
Multi Engine Course

Previous Experience

Total Hours

Dual Instruction

Solo or Pilot-In-Command

Licenses / Ratings Held

Issuing Country

FAA Medical (Class and Date)

Physical Record

Age

Date Of Birth (mm/dd/yy)

Place of Birth
(City and County)

Statement of General Health

Passport Information

Country Issuing Passport

Passport Number

Passport Expiration Date

American Embassy/Consulate Nearest You

Married

Yes No

Number of Dependents

Current occupation before coming to the United States (example: student, job title)

In Case of an Emergency, Please Contact:

Name

Address

Phone

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