Student Intake

Personal Information

First Name* Last Name* Date of Birth Phone Number* Email Address* Mailing Address City State / ZIP Emergency Contact Name Emergency Contact Phone

Flight Experience

Total Flight Hours Hours Last 12 Months Instrument Hours (Actual / Hood) Primary Aircraft Flown Hours in Type

Glass / EFIS Experience

Yes No

Aircraft You Own or Regularly Fly

Referral & Acknowledgment

How Did You Hear About The Pragmatic Pilot? Referred By (Name, if applicable)

By signing below, I confirm that the information provided is accurate to the best of my knowledge. I understand that The Pragmatic Pilot reserves the right to decline or discontinue training at any time for safety-related reasons. I accept responsibility for maintaining currency of my medical certificate and ensuring my aircraft is airworthy prior to any dual instruction.

Student Signature (type full name)* Date*

Sent securely to The Pragmatic Pilot

Personal Information

Medical Certificate

Certificates & Ratings Held

Flight Experience

Aircraft You Own or Regularly Fly

Aviation Goals & Training Objectives

Referral & Acknowledgment

Thank you

Student Intake

Personal Information

Medical Certificate

Certificates & Ratings Held

Flight Experience

Aircraft You Own or Regularly Fly

Aviation Goals & Training Objectives

Referral & Acknowledgment

Thank you

Get in Touch

Message Sent