Domestic Student Application Form

Applicant Details:
Full Name *

First Name Middle Name Last Name
Birth Date *

Month Day Year
Phone Number *

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

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
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 Code Phone Number
Aviation Medical Information:
Category of Medical *
Date of Medical Exam

Year Month Day
Date
Name of Canadian Aviation Medical Examiner
Course of Study Applied for:
Name of Course: *
Mode of study: *

Full time Part 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

PPL CPL
Fees Information:

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

Yourself Sponsor
Please complete the following if you are recieving funds from a third party
Sponsor or Agency's Name

First Name Last Name
Email
example@example.com
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Educational Background:

Please give details of all Schools/Colleges/Universities attended.

Secondary / Post - Secondary Education *

	Name of secondary School/College/University	Dates Attended From(mm/yy)To(mm/yy)	Program Completed

Please include a copy of of your most recent transcript *

Browse Files

Cancel of
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 Code Phone Number
Declarations:
Do you have any criminal convictions? *

Yes No
Have you ever been charged with impaired or dangerous operation of a motor vehicle? *

No, Yes, impaired driving Yes, dangerous driving
Criminal Record or Impaired Driving Convictions:

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 ciminal record may be an impediment to future job opportunities. Students with a criminal conviction for which they have not recieved a pardon are advised to investigate their potential oportunities 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.
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 *

day month year
Signature

Clear
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Applicant Details:

Aviation Medical Information:

Course of Study Applied for:

Previous Aviation Training

Fees Information:

Educational Background:

Statement In Support Of Application:

Reference:

Declarations: