Enrollment

M1 Visa Application

Yes

Personal Information
* First name

Middle

* Last name

* Date of Birth and Place of Birth

* Country of Birth

* Country of Citizenship

* Gender

Height/Weight (inches/lbs)

Address Information
Street Address

* City, Province or Territory, Zip Code

* Country of Residence

Contact information
You will receive a copy of this email.
* email

* Home/Work Phone

Alternate Phone

Passport Information
Passport Number

Passport Issue Date

* Country of Issue

Expiration Date

SSN or Driver's License Number

Occupation/Employer

Current license(s) held

Current Medical

Current Flight Time
TT Flight Time

Arrival
* Date of Arrival

Airline/Flight Number

Time of Arrival (Flight)

Arrival Airport

Departure
* Date of Departure

Airline/Flight Number

Time of Departure (Flight)

Airport Shuttle Service
Airport Shuttle

Training/Rental

* First day at Florida Flyers (Date)

FAR Part 61

FAR Part 141 Program

Aircraft selection
* Make and model of first airplane (preferred)

Make and model of alternate airplane

Letter of Authenticity
Required for IR-CPL-ME based on a non-FAA license or validation of a foreign license

Yes

Applied for Letter of Authenticity?

yes

Letter of Authenticity Number, Date of Issue and FSDO or application date

Ground Training
Ground School

Language Skills
My English language level is

Language Training

Please schedule language training for me

No language training needed

I will need language training on xx days per week
Schedule Language training

Accommodation

Please type any additional comments or questions in this box.
Comments

Confirmation
I represent that the answers given are true and complete to the best of my knowledge and belief and that no material information has been withheld.

I agree

I do not agree (cancel)

My electronic signature
* Electronic Signature

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