Student Application Form

Applicant Information
First Name*
Last Name*
Initial*
Email*
example@example.com
Home Phone Number
Please enter a valid phone number.
Cell Phone Number*
Please enter a valid phone number.
Take Your Photo
Address*

Street Address

City/TownProvince/State

Postal Code/Zip Code
Date of Birth YYYY/MM/DD*
Social Insurance Number
This is for Federal T2202 Tax Form
Health Care Province/State
Health Care Number
Driver's Licence Number*
If you don't have a Driver's Licence number, simply put "N/A" in the box.
Passport Number*
If you don't have a passport number, simply put "N/A" in the box.
Upload Copy of your Driver's Licence and Passport*

If you don't have a passport, kindly upload your birth certificate.
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Emergency Contact Information
Name*
Phone Number*
Please enter a valid phone number.
Address*
Relationship*
Personal Doctor Contact Information
Doctor Name
Doctor Contact Number
Please enter a valid phone number.
Personal Health Insurance Information
Carrier
Blue Cross, Sun Life, Other
Plan Number
Allergies (List if any)
Additional Info (If any)
All the above information is strictly confidential and for office use only. The above information will not be shared or distributed with any other person(s) not associated with L R HELICOPTERS INC. unless in the event of an emergency.

Previous Aviation Experience
Aviation Background
Previous Flight Training School
Aircraft Types Flown
Total Flight Hours
PIC Hours
Dual Hours
Aviation Medical Class
Medical Date

MonthDayYear
Date
Upload a copy of your Aviation Medical

* Proof of a valid medical is required prior to training.
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Upload a copy of your logbook

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Upload a copy of your pilot license

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English Exam Results | International Students Only

You can prove this by passing the IELTS exam
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