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MAZZEI FLYING SERVICE
School of Aeronautics

4885 East Shields Avenue, Suite 201
Fresno, California 93726, U.S.A.
(559) 251-7501 - Fax (559) 255-8900
Toll Free (U.S. only): 1-800-622-8687

Application for Enrollment

PART A
STUDENT INFORMATION

Last Name
First Name
Middle Name
Soc. Sec. No.
Street/Postal Add.
City
State
Country
Zip
Telephone Number
Email Address
Height	'ft "in
Weight	lbs
Birth Country & City
Birthday	Month/Day/Year
Citizenship
Passport Number
Expires	Month/Day/Year
In Case of Emergency
Notify Name
Relationship
Address
Telephone
High School Grad	Yes No College Grad Yes No
Knowledge of English	Good Fair Poor None
VISA Prog. Requested	M-1 Student (1-20) Other
Do you have Health and Accident Insurance for the U. S.? Yes No
How did you learn about Mazzei Flying Service?

PART B
FLIGHT INFORMATION

Pilot Certificate	None Student Private Commercial ATP
Date of Issue	Month/Day/Year
Certificate Number
Country of Issue
Ratings
Pilot Medical Certificate	None FAA Other
Class
Date
Hours of logged pilot experience:	None

Type hours in the boxes	Airplane	Helicopter	Glider
Pilot-In-Command/Solo
Dual Instruction
Instrument
Night
Cross Country >50nm
Retractable Gear
Multiengine
Simulator

PART C
COURSE ENROLLMENT INFORMATION

Flight training course option requested:
	Airplane Helicopter Completion Guarantee Non-guarantee
Living accomodations requested:
	School provided apartment:
	Shared bedroom
	Private bedroom
	Private apartment
	Free school provided apartment
	Shared bedroom
	Private bedroom upgrade
	Private apartment upgrade
	Will arrange own accomodations
Housewares package requested:	Yes No
Student health and accident insurance requested:	Yes No
Arrival date:	Month/Day/Year
Start date:	Month/Day/Year
Departure date:	Month/Day/Year
Payment information (to pay by credit card or money order) Application fee for International Applicants - $500 Application fee for US Applicants - $150
Method of Payment:
Credit Card No:
Expiration Date (month):
Expiration Date (year):

Comments:

PART D
CERTIFICATION

Please check the box to acknowledge the following statements:

I understand that MFS accepts no responsibity for applicant during the time applicant is not involved directly in flight training activities. Additionally, I will not hold MFS liable for damages, negligence, or infractions of any law incurred be applicant while not directly involved with flight training at MFS.

I certify that all information submitted by me in this application is true and correct.

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