STUDENT ENROLLMENT APPLICATION
APPLICATION INSTRUCTIONS : TYPE OR PRINT CLEARLY IN ALL CAPITAL LETTERS. PERSONAL INFORMATION All information must be given & entered as it appears on passport
Name
*
First Name
Middle Name
Last Name
Birth Date
*
-
Month
-
Day
Year
Gender
*
Please Select
Male
Female
N/A
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Mobile Number
*
-
Country Code
Phone Number
Blood Type
*
Please Select
A
B
AB
O
Clothes Size
Please Select
S
M
L
XL
XXL
Shoe Size
Please Select
46
45
44
43
42
41
40
39
38
37
36
35
Size EU
Height
Cm
Weight
Kg
Back
Next
Emergency Contact
Parents Name
*
Contact Phone
*
-
Country Code
Phone Number
Email
*
example@example.com
Back
Next
Visa Requirements
City of birth
*
Country of birth
*
Country of citizenship
*
Passport Requirements
No Passport
*
Passport Issuance
*
Passport issue date
*
-
Month
-
Day
Year
Date
Passport expiration date
*
-
Month
-
Day
Year
Date
Passport photo
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Photo
*
Browse Files
Drag and drop files here
Choose a file
photo with red background
Cancel
of
Back
Next
Flight training details to be completed by Perkasa Flight School sales executive
Training program
*
PPL Exclusive
PPL, CPL-IR Single Engine Rating package
CPL AB INITIO (PPL, CPL,-IR, Multi Engine Rating and ATP Theory) package
Multi Engine Rating
ATP Theory
Flight Instructor Course Single Engine Rating
Flight Instructor Course Multi Engine Rating
PPL License Endorsement
CPL-IR License Endorsement
Pilot Refresher Course
Flight Instructor Refresher Course
Tuition Fee
*
Select Payment
Cash Payment USD 60,000
3x Payments USD 62,000
10x Payments USD 67,000
Payment 1 (at least 1 week before training starts) USD 24,800
Payment 2-3 (after 25 flight hours & PPL Checkride) USD 18,600
Payment 1 (when passing the test & before training starts) USD 13,000
Payment 2-5 (after PPL theory test & 15, 30, 45 flight hours) USD 6,000
Payment 6-10 (after 60, 75, 90, 105, 120 flight hours) USD 6,000
Tuition Fee
*
Select Payment
Cash Payment USD 63,000
3x Payments USD 65,000
10x Payments USD 70,000
Payment 1 (at least 1 week before training starts) USD 26,000
Payment 2-3 (after 25 flight hours & PPL Checkride) USD 19,500
Payment 1 (when passing the test & before training starts) USD 15,100
Payment 2-5 (after PPL theory test & 15, 30, 45 flight hours) USD 6,100
Payment 6-10 (after 60, 75, 90, 105, 120 flight hours) USD 6,100
Back
Next
Arrival and training start dates
Requested training start date
*
Please Select
Batch 45 (20 February 2023)
Batch 46 (22 May 2023)
Batch 47 (17 July 2023)
Batch 48 (18 September 2023)
Batch 49 (20 November 2023)
Other
Planned arrival to
*
-
Month
-
Day
Year
Must arrive 2 weeks before training
Estimated departure date
*
-
Month
-
Day
Year
Date
How did you hear about Perkasa Flight School?
Please Select
Social Media
Website
Advertisement
Perkasa Marketing Agency
Perkasa Student
Perkasa Sales Executive
Others
Thus, this cooperation agreement was prepared consciously and truthfully.
Signature
Clear
Submit
Reset Form
Should be Empty: