APPLICATION Aviation Career Education ACE Academy June 20-24, 2011 ELIGIBILITY: Applicants must be current full-time students entering their junior or senior year of high school after the summer of 2011. There are ONLY 30 slots available on a first come, first serve basis and only fully completed applications will be accepted. If you are selected for the camp, you will be notified by phone and e-mail about when to send in the tuition fee. The applications are DUE BY MAY 20, 2011. A program schedule and further information will be included with notification. If there are more than 30 applications or you send in your application past the deadline, your name will be put on a waiting list. Waiting list students will be notified if a slot becomes available. COST: The tuition fee is $100 which covers course costs. Five students will be awarded free tuition by writing a 5 paragraph essay on what interests them in aviation. Suggestions could include; past experiences in the aviation field, a figure in aviation who inspired you or how aviation changed history. If their essay submission is selected, the chosen recipients will be informed by May 27, 2011. The remaining students will be notified of the date when their tuition fee will be due. TRANSPORTATION: Student/parents are responsible for transportation to drop-off and pick-up locations near the Miramar Marine Corp Air Station. The exception will be day 5, where the students will require a drop-off and pick-up at an alternate location in San Diego County(TBD). Additional information will be provided with the notification letter. ADDITIONAL INFORMATION: Academy directors include professional staff in the aviation field. Send your application to : Federal Aviation Administration ATTN: Marvin Medina/ACE 9175 Kearny Villa Road San Diego, CA 92126 For questions, please contact Kristin Grulke at 760-500-3946, Kevin Karpe at 858-537- 5881 or Tony Marshall at 760-247-0456. NAME DATE OF BIRTH HOME ADDRESS CITY STATE ZIP CODE PHONE GRADE LEVEL YOU WILL ENTER FALL 2011 GPA LIST THE NAME(S) OF WHO IS AUTHORIZED TO PICK UP STUDENT:
CIRCLE T-SHIRT SIZE: S M L XL XXL
STUDENT PROFILE RELATE ANY SPECIAL INTERESTS THAT YOU HAVE RELATING TO AVIATION OR AEROSPACE. LIST SCHOOL ACHIEVEMENTS OR AWARDS AND EXTRACURRICULAR ACTIVITIES. DESCRIBE HOW ATTENDING THE ACE ACADEMY WOULD BENEFIT YOU.
COUNSELOR/TEACHER RECOMMENDATION: Please describe the student s interest in aerospace, self-motivation, attitude, maturity, academic ability, honesty, attendance or other special qualities. Letters of recommendation or additional comments may be added to this application. Teacher/Counselor Signature Date School Phone STUDENT: If accepted, I will attend the full program. Student Signature Date PARENT/GUARDIAN NAME ADDRESS HOME PHONE WORK PHONE BEST TIME TO CALL As the parent/guardian of the student, I certify that my child has permission to participate in the ACE Academy. I understand that he/she will receive an introductory airplane flight. I ensure that my child will attend the full program, that they are subject to the guidelines of the program and can be removed for inappropriate conduct. PARENT/GUARDIAN SIGNATURE DATE
GENERAL RELEASE (WE) (I), the undersigned, of (Parent(s) or Guardian(s)), a minor (Name of Student) herein, do hereby give (our) (my) consent for said minor to participate in all academy activities, including but not limited to airplane orientation flight training experience and field trips. (WE) (I) do hereby remise, release, and forever discharge and do by this instrument, for (ourselves) (myself) heirs, executors, administrators and assigns, on behalf of (ourselves) (myself) and on behalf of said minor herein, remise release and forever discharge the ACE Sponsors; all flight instructors, all pilots; all volunteers working with the ACE Academy from all and any manner of action and actions, cause and causes of action, suits, debts, dues, sums of money, damages, personal injury claims, wrongful deaths claims and all demands whatsoever, in laws, in admiralty or in equity, arising out of the ACE Academy activities. This release may not be changed orally. Parent/Guardian, on behalf of myself and said minor herein Date Student s Social Security Number Photo Release I grant the workplace permission to photograph my son/daughter, for promotional and educational (name) purposes? Yes No
PARENTAL MEDICAL CONSENT NAME OF STUDENT If it should become necessary, I hereby give my permission to the ACE Academy and to its agents, to secure emergency medical treatment at the nearest medical facility for my minor child while under the care and supervision of agents of the ACE Academy. Does your minor child possess any physical or mental defects requiring special attention, such as epilepsy, hard of hearing, diabetes, asthma, etc.; treatment or medication/or that would make it difficult for them to participate in the ACE Academy Activities? Yes No If yes, please explain: List all medications child is currently taking: Are there any dietary restrictions? Does your child suffer from motion sickness? Parent/Guardian Signature (Date) Name of Medical Insurance (Policy No.) Father s/guardian s Name: Home Phone: Address: Place of Employment: Work Phone: Mother s/guardian s Name: Home Phone: Place of Employment: Work Phone: IN CASE OF EMERGENCY CONTACT: PHONE NO.