Application For Admission

Please complete the following information. This is the first step in the admissions process. We look forward to helping you reach your career goals. Thank you for choosing SimPilot Peru S.A. (Agent). The form below is sent through a Secure Server. An Admissions Officer will review your application and contact you. Privacy Policy.

Personal Information

Sex

Male Female

Marital Status

Married Single Divorce Widowed

Have you ever been convicted of a crime, weather felony or misdemeanor in the U.S. or in any other country?

Yes No

(if yes please explain and provide SimPilot Peru S.A. (Agent) with a certified copy of the final disposition in this matter):

Education

High School

College

Graduate School

Programs and Courses

Previous Flying Experience

Note: If you have received prior flight training at a Part141 school please provide a certified transcript of training. Credit will be awarded when records are audited by our chief Flight Instructor.

In Case of an Emergency, Please Contact:

Proof of U.S. Citizenship (U.S. citizens and nationals only):

An individual must present either of the following documents:

Valid unexpired United States passport Original or Govermment-issued certified birth certificate Original United States naturalization certificate Original certificate of birth abroad with raised seal, U.S. Departement of State Form FS-545

Are you applying for VA benefits?

Yes No

Do you possess a Green Card

Yes No

Do you have a statement or certificate that states English proficiency based on academic or practical experience?

Yes No

If yes, please state type and submit documentation:

Are you requesting housing?

Yes No

To be admitted ALL students must:

1. Complete application

2. Send
• Copy of driver license
• Pilot licenses (if applicable)
• Copy of passport
• Copy of high school or college transcript.
• Current FAA medical certificate
• The last two pages of log book (if applicable)

3. Include non-refundable registration fee of $150.00. International students must: 4. Send copy of health/accident insurance
• Financial letter of affidavit support
• Visa (if applicable)
• 1-20 form (if applicable)
• I-94 form (if applicable)
• Non-refundable international fee of $500.00

Note: International students must have their license and ratings translated into English language.

STUDENTS PLEASE READ AND SIGN

I have received and acknowledge the contents of the school catalog required to obtain admission to SimPilot Peru S.A. (Agent) and register for the courses that I have requested. I understand that withholding information requested in this application or given false information may make me ineligible for admission. I certify that the above statements are correct and complete.

IF YOU ARE UNDER 18 YEARS OF AGE

If you are under 18 years of age, the application must be signed by a parent or legal guardian.

The undersigned, being the

Parent Legal Guardian of the above named applicant

consents to his/her application for admission at SimPilot Peru S.A. (Agent)

How did you learn of SimPilot Peru S.A.?

Friend/Student Website Magazine Radio/TV

Evaluation (Official use only)

Accepted Denied

Comments

Credit Card Payment Information

Name on Credit Card:

Type of Credit Card:

Visa Mastercard American Express

Credit Card #

Expiration Date

Address on Account:

City

Zip

Country

Phone

Credit Card Authorization

I

hereby authorize SimPilot Peru S.A. to charge my credit card #:

In the amount of: $

Signature

Date

Print Name

DNI

Passport#

Country