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Sierra Academy of Aeronautics Application

General Information :

Last Name :

First Name :

Middle Initial :

Date of Birth :

Sex :

Male Female

Citizenship :

Social Security Number :

Email :

Present Address :

Street :
City :
State :
Zip :

Permanent Address :

Street :
City :
State :
Zip :

Day time Phone :

Evening Phone :

Physical Condition :

Height :

Weight :

Hearing Difficulty :

Yes	No
Explain if yes :

Vision :

/20
If less than 20/20
corrected to: /20

What is your general physical condition :

FAA Medial Certificate held, if any :

Class:
Date issued:

Education Background :

High School :

City :

State :

Dates attended :

From:
To:

Graduated :

Yes	No
If No : GED: Yes No
Date :

College / University :

City :

State :

Dates attended :

To:
From:

Major :

Graduated :

Military Background :

Branch :

Rank :

Months of active duty :

Last day of duty :

Eligible for the GI Bill :

Yes No

Aviation Employment Background :

Please list employers, positions, duties and periods of employment :

Aviation Experience : (None Required)

Certifications/Ratings held :

FAA written exams passed :

Aviation schools attended :

Locations:
Programs:
Approvals:
Date:

Total flight hours :

FAA approved school flight hours :

Dual:
Solo:

Courses Desired : (check all that apply)

	Commercial pilot – includes instrument rating and multi-engine certification
	Flight Instructor (CFI and CFII)
	Flight Instructor - Multi-Engine
	Airline Transport Pilot (ATP)
	Complete Professional pilot program (all of the above components) with the Direct Track Internship
	Aircraft Dispatcher

College Degree Option : (check all that apply)

A corresponding application from Embry-Riddle Aeronautical University will be provided if you indicate an interest in this option

	Associates Degree – Professional Aeronautics
	Bachelor of Science – Professional Aeronautics
	Master of Science – Business Administration in Aviation

Class Dates Requested :
(classes start on the first Monday of every month)

1st choice month :

2nd choice month :

Housing Referral Request :

	Please be advised of my interest in housing in this area.
	Please send me current information you may have of housing near your training facility.

Special Requests :

Please let us know of any special requests that you may have :

Referrals :

Please let us know if you have any friends that may be interested in a career in aviation.

Referral 1 :

Name :

Street address :

City :

State :

Zip :

Phone :

Email :

Program :

Referral 2 :

Name :

Street address :

City :

State :

Zip :

Phone :

Email :

Program :

How Did You Hear About Sierra Academy :

Referral – please
provide the
name of the organization / individual :

Magazine Advertisement – Magazine Name :

Internet search engine :

Other :

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