Online Student Application

Please fill out the following student application to begin your flight training at Cindtronix. If you would like to print out a paper version of our student application, click here.

Personal Data
Name (Last, First, MI)

Street Address
City
State
Zip

E-mail Address
Home Phone
Cell Phone
Additional Contact Info

Date of Birth (MM/DD/YY) *
Parent's Name (if under 18)
Parent's Phone (if under 18)
Emergency Contact Information
Name (Last, First, MI)
Primary Phone

Street Address
City
State
Zip

Additional Phone Number(s)
Course Information
Requested Course Enrollment:
Other applicable information
Check the following if	... you are flying under a waiver ... you ever had your FAA or DOT certificate suspended or revoked ... you ever had an accident, incident, or violation ... any aviation insurance company cancelled, declined, or refused you insurance ... you ever had been convicted or pleaded guilty of reckless driving or driving under the influence ... your drivers license has ever been suspended or revoked ... you have ever been convited or if you are under indictment in a legal action involving illegal drugs ... you have ever been convicted or a felony
Please present the following to the Cindtronix dispatcher:	Valid U.S. Passport or original U.S. Birth Certificate and ID Driver's License or government photo ID Pilot Certificate (as applicable) Medical Certificate (as applicable)
Yes, I certify that I have reviewed the above information to be correct.
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* If applicant is younger than 18: Approval of Parent/Guardian is required in order for applicant to begin flight training. Written permission is required for such applicants and may be mailed, faxed, or given in person.

© 2010 - Cindtronix Aviation
210 Airport Street | N. Kingstown, RI 02852 | 300 Jenckes Hill Road | Smithfield, RI 02917 | (401) 667-7580