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Application 2018

PEA

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SIMEON NYANZI
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12 views

Application 2018

PEA

Uploaded by

SIMEON NYANZI
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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APPLICATION FOR ADMISSION Please Return

International Students Completed Application to:


PEA INTERNATIONAL FLIGHT TRAINING ACADEMY Jan Blonk
561 Pearl Harbor Drive, Daytona Beach, Florida 32114 USA ADMISSIONS OFFICER
+1 (386) 258-0703 ● 1 (800) 868-4359
www.pea.com ● [email protected]
[email protected]

FULL NAME (First, Middle, Last) SIMEON NYANZI


E-Mail [email protected] Phone Number + 256755332074
Country Code Area Code Number
Permanent Address (In Country of Citizenship):
Street Address NANFUBAMBI ROAD City KAMPALA
State/Province/Territory MAKERERE Postal Code Country UGANDA

Local Address (Where you Currently Reside):


Street Address NANFUBAMBI ROAD City KAMPALA
State/Province/Territory MAKERERE Postal Code Country UGANDA

Married? ⎕
✔ YES ⎕ NO Number of Dependents 2 Will they be coming with you to the U.S.? ⎕
✔ YES ⎕ NO

PHYSICAL RECORD
Age 28 Date of Birth (Month/Day/Year) SEPTEMBER 15 1990 Place of Birth (City/Country) KAMPALA/UGANDA

PASSPORT & CONSULAR INFORMATION


Passport Issuing Country UGANDA Passport # B1197116 Passport Expiration Date MARCH 24 2025
U.S. Embassy/Consulate Where You Intend to Interview (City/Country) KAMPALA/UGANDA

COURSE INFORMATION
Date You Want to Begin Training: APRIL 1 2019
✔ Private Pilot Course + Professional Program I (F-1)
⎕ ⎕ Private Pilot Course + Professional Program III (F-1)
⎕ Basic with Multi Engine Program (M-1) ⎕ Other (M-1):

PREVIOUS FLIGHT EXPERIENCE


TOTAL HOURS Dual Instruction Hours Solo/PIC Hours
Licenses / Ratings Held STUDENTS PILOT'S LICENCE Issuing Country UGANDA FAA Medical (Class/Date)
Note: International students must have their license and ratings translated into English by the Aviation Authority of the country where the license was issued.

Have you enclosed a statement of English proficiency based upon academic or practical experience? ⎕
✔ YES ⎕ NO

EMERGENCY CONTACT INFORMATION


Full Name ALICE NYANZI Phone Number +256 772332512 Relationship MOTHER
Address MAKERERE - KIKONI ZONE C, KAMPALA Country COUNTRY

STUDENTS - PLEASE READ AND SIGN BELOW


I have received and understand the contents of the school catalog and wish to gain admission to Phoenix East Aviation
and register for the course that I have specified. I certify that the above statements are correct and complete.

Applicant Signature SIMEON NYANZI Digitally signed by SIMEON NYANZI


DN: cn=SIMEON NYANZI, o, ou, [email protected], c=UG
Date: 2017.01.21 03:56:35 -08'00'
Date NOVEMBER 18 2018

IF YOU ARE UNDER 18 YEARS OF AGE:


If the applicant is under 18 years of age, the following 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 Phoenix East Aviation.

Signature Phone Number


Address City/State/Province Country

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