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Northwoods Air Intake Questionnaire
We're so excited to have YOU in the pilot's seat! Please answer the following questions to the best of your ability. We understand that some of the questions are personal, but this is tailored to ensure nothing gets missed, and there are no delays in your training. Your information will be kept confidential. Thank you!
1. Full Name
1. Full Name
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2. Date of Birth
2. Date of Birth
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3. E-mail
3. E-mail
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Mailing Address
Mailing Address
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4. Best Daytime Phone Number
4. Best Daytime Phone Number
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5. Are you a United States citizen?
5. Are you a United States citizen?
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Yes
No
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add "Other"
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6. Do you currently hold a United States drivers license, in good standing?
6. Do you currently hold a United States drivers license, in good standing?
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7. Do you currently hold a United States passport, in good standing?
7. Do you currently hold a United States passport, in good standing?
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add "Other"
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8. What is your goal of learning to fly?
8. What is your goal of learning to fly?
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Career Pilot
Hobby / Recreational Pilot
Other
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add "Other"
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9. Do you have any prior flight experience? Previous airframes?
9. Do you have any prior flight experience? Previous airframes?
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10. If you expect to continue with full time instruction, how often do you anticipate flying?
10. If you expect to continue with full time instruction, how often do you anticipate flying?
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2-3 times per week
1-2 times per week
Weekly
Biweekly
Couple of times a month
Other
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11. Do you already have a FAA medical?
11. Do you already have a FAA medical?
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12. Have you ever been convicted of any of the following: DUI, drug use, violent crimes, or otherwise felony record that could impact your ability to obtain a pilot's license?
12. Have you ever been convicted of any of the following: DUI, drug use, violent crimes, or otherwise felony record that could impact your ability to obtain a pilot's license?
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Yes
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add "Other"
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13. Do you have any medical conditions that could affect your ability to fly, such as epilepsy, heart disease, or vision problems?
13. Do you have any medical conditions that could affect your ability to fly, such as epilepsy, heart disease, or vision problems?
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Yes
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add "Other"
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14. Do you have any physical limitations or disabilities that could affect your ability to fly, such as limited mobility or hearing impairment?
14. Do you have any physical limitations or disabilities that could affect your ability to fly, such as limited mobility or hearing impairment?
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Yes
No
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add "Other"
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15. Have you ever been diagnosed with a mental health condition that could impact your ability to safely operate an aircraft?
15. Have you ever been diagnosed with a mental health condition that could impact your ability to safely operate an aircraft?
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add "Other"
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16. Are you currently taking any medications that could affect your ability to operate an aircraft?
16. Are you currently taking any medications that could affect your ability to operate an aircraft?
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add "Other"
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17. If you answered "yes," to any of the questions 12-16, please explain.
17. If you answered "yes," to any of the questions 12-16, please explain.
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18. Would you like to schedule a Discovery Flight?
18. Would you like to schedule a Discovery Flight?
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Already scheduled
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19. Do you agree to adhere to our Cancellation Policy? A copy can be found on the home page of Flight Schedule Pro.
19. Do you agree to adhere to our Cancellation Policy? A copy can be found on the home page of Flight Schedule Pro.
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add "Other"
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20. Do you agree to adhere to our Credit Card Policy? A copy can be found on the home page of Flight Schedule Pro. This includes providing credit card information to Flight Schedule Pro before instruction is provided.
20. Do you agree to adhere to our Credit Card Policy? A copy can be found on the home page of Flight Schedule Pro. This includes providing credit card information to Flight Schedule Pro before instruction is provided.
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Short answer
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Yes
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add "Other"
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21. How did you hear about us?
21. How did you hear about us?
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22. Additional questions or relevant information
22. Additional questions or relevant information
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