Flight Technology Entrance Application | Aviation Academy

Today's Date: *

Month

Day

Year

Term & Year Planned to Enter: *

Name: *

(Last, First, Middle)

L#

Home Telephone:

(555) 555-5555

Cell Telephone:

Current Address: *

City, State, Zip: *

Date of Birth: *

Email Address: *

Gender: *

Male

Female

I am a: *

U.S Citizen

Permanent Resident

Other

State of Legal Residence: *

U.S. & Permanent Residents Only

What is your Alien Registration Number?

What is your Country of Citizenship?

What is your Country of Birth?

If you are an International Applicant, Do you Currently have a Visa to Immigrate to the U.S.?

Yes

No

If Yes, what type?

High School Graduate?

Yes

No

GED?

Yes

No

If no diploma or GED received, last year completed:

Name, Major and Credits earned for all Colleges/Universities attended:

Have you taken any LCC Flight Technology courses before?

Yes

No

LCC Courses/ Year Taken/Flight Hours (if any):

Training Program Desired:

Degree Program (Professional Pilot Course with AAS Degree or AAOT

Commercial/Instrument License

Flight Instructor - Airplane

Add-on Instrument Rating Only

Private License Only

Multi-engine

Flight Instructor-Instrument

What are your aviation career goals?

Do you have any previous aviation flight or job experience?

Flight School Attended, Location, Instructor Name, Date