STUDENT ENROLLMENT APPLICATION

STUDENT ENROLLMENT APPLICATION FORM

APPLICATION INSTRUCTIONS : Please complete all required fields accurately. All personal information must match the applicant's passport.
Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Mobile Phone Number

Country CodePhone Number
Blood Type
Uniform size (short-sleeved)
Long Pants Size
Shoe Size
Size EU
Height
Cm
Weight
Kg

Visa Requirements
City of Birth
Country of birth
Nationality / Citizenship
Passport Requirements
Passport Number
Passport Issuing Authority
Passport Date of Issue

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Passport Date of Expiry

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Passport Copy

Copy of Passport (Bio data page)
Cancelof
Photo (Colour Photograph 3 × 4 cm with a Red Background)

Cancelof

Arrival and training start dates
Preferred Training Start Date (include batch/intake if applicable)
Expected Departure Date from Home Country

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Expected Arrival Date in Indonesia

MonthDayYear
2 digit month, 2 digit day, 4 digit yearYou must arrive two weeks before your training start date
I hereby declare that all information provided in this application is true, accurate, and complete to the best of my knowledge.
I understand that false or misleading information may affect my application and enrollment at Perkasa Flight School.
Signature
Should be Empty:

STUDENT ENROLLMENT APPLICATION FORM