Domestic Student Application Form

Applicant Details:
Full Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Phone Number*

Area CodePhone Number
E-mail*
example@example.com
Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Native Language*
All students must pass either a formal or informal English Language demonstration to hold a pilot license. If you have not completed Canadian high school in English, please see the information on the formal Aviation English Language Demonstration.
Person to contact in case of emergency:*
Parent/Guardian
Relationship*
ex. Father, Mother, etc.
Phone Number*

Area CodePhone Number
Emergency contact email
example@example.com
Aviation Medical Information:
Category of Medical *
Date of Medical Exam

YearMonthDay
Date
Medical file number if available
Course of Study Applied for:
Name of Course:*
Mode of study:*

Full timePart time
Proposed start date (Month,Year):*
Previous Aviation Training
Name of previous Flight Training Unit or College
Total Flight Time
Total Dual Time
Total Solo Time
Ground school completed

PPLCPL
Fees Information:

Please provide details of who be paying your fees.
Who is expected to pay your fees?*

YourselfSponsor
Please complete the following only if you are recieving funds from a third party
Do we have your permission to contact this person/ agency on your behalf?

YesNo
Sponsor or Agency's Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Educational Background:

Please give details of all Schools/Colleges/Universities attended.
Highest level of education completed*
If applying for the Aviation Management certificate please include a copy of your latest transcript. An official transcript will be required to finalize registration.

Browse Files

Cancelof
Statement In Support Of Application:

This section must be completed. You should state why you want to undertake this course, any relevant experience, skills and attributes, and your long terms goals.
*
Reference:

Please provide at least 1 reference who is not a family member.
Name of reference *
Relationship to you*
Phone Number of Reference *

Area CodePhone Number
Declarations:
Do you have any criminal convictions?*

YesNo
Have you ever been charged with impaired or dangerous operation of a motor vehicle?*

No,Yes, impaired drivingYes, dangerous driving
A criminal or motor highways record may not automatically prevent admission to Brandon Flight Centre. However, students wishing to pursue a career in the aviation industry should understand that a criminal record may be an impediment to future job opportunities. Students with a criminal conviction for which they have not received a pardon are advised to investigate their potential opportunities in the career path they have chosen prior to commencing flight training. Brandon Flight Centre shall not be held liable for any student unable to secure post-graduate employment.

I have read and understand the above statement regarding criminal convictions or motor vehicle offenses.
Protection for Personal Information:

The information you provide will be used for the purposes of determining eligibility for admission and financial aid and awards, assessment of academic status, statistical analysis, and communication with the applicant. Your information may be disclosed to other educational institutions for the purpose of determining eligibility for admission into joint-programs and it may be disclosed to government departments and co-sponsoring organizations to determine eligibility for financial aid and awards. Your personal information will not be used or disclosed for other purposes, unless permitted by The Freedom of Information and Protection of Privacy Act (FIPPA). If you have any questions about the collection of personal information, please contact Brandon Flight Centre at 204-728-7691.
How did you find out about Brandon Flight Centre?*
Declaration I certify that, to the best of my belief, the information I have provided is complete and true.
Date*

daymonthyear
Signature

Clear
Should be Empty:

Applicant Details:

Aviation Medical Information:

Course of Study Applied for:

Previous Aviation Training

Fees Information:

Educational Background:

Statement In Support Of Application:

Reference:

Declarations: