Step 1 of 5 20% First Name* Middle Name Last Name* Preffered Name Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Email* Date of Birth* MM slash DD slash YYYY Birthplace* Citizenship* Brothers or sisters (list name and age) Father's InformationFather's Full Name (First, Middle, Last) Father's PhoneFather's Occupation Mother's InformationMother's Full Name (First, Middle, Last) Mother's Occupation Mother's Phone School & ActivitiesPlease tell us about your education and extracurricular activities. School Attending* Grade Level*101112OtherOther SchoolsSubjects and GPAExtracurricular ActivitiesHobbiesEmployment and/or Volunteer RecordCompany or Employer Name Position Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY End Date to Present to Present Add Another Employment Add Another Company or Employer Name Position Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY End Date to Present to Present Please describe any flying experiences you have had in any type of aircraft. ReferencesName First Last PhoneName First Last PhoneName First Last Phone Please include a statement of 500 words or less on the following topic: “Why I Would Like to Become a Pilot”*Agreement* I consent to having Decatur EAA store my submitted information so they can review my application and contact me by email or phone.
