Participant Information

First Name *

Last Name *

Gender *

Male
Female
No elements found. Consider changing the search query.
List is empty.

Child's Age *

9
10
11
12
13
14
15
16
No elements found. Consider changing the search query.
List is empty.

Date of birth *

Address *

City *

State *

Postal code *

School Information

Name of School *

Current Grade Level *

8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
No elements found. Consider changing the search query.
List is empty.

Have you taken any advanced math or science classes? *

Yes
No
No elements found. Consider changing the search query.
List is empty.

Please list all of the advanced math or science classes that you have been previously been enrolled in. *

Prior Avition Experience or Exposure

Have you previously participated in our aviation program? *

Yes
No
No elements found. Consider changing the search query.
List is empty.

Have you ever been enrolled into any sort of Aviation Instructional program? *

Yes
No
No elements found. Consider changing the search query.
List is empty.

Please list all of the prior Aviation Instructional programs that you have been previously been enrolled in. * *

Have you ever taken or participated in a Discovery Flight? *

Yes
No
I don't know what that is
No elements found. Consider changing the search query.
List is empty.

Are you currently or will you be enrolled into any extracurricular activities during the timeframe of our sessions? *

Yes
No
No elements found. Consider changing the search query.
List is empty.

Please list all of extracurricular activities that you are or will be enrolled in during the Spring 2025 Cohort class sessions. Please also include the dates and times that they will meet. *

Program Fit & Committment

Why do you feel that the Alexandria-Fairfax (VA) Aviation Program would be a good fit for your participant? *

If selected for the program, are you willing to commit to attending all sessions on the scheduled dates? *

Yes
No
No elements found. Consider changing the search query.
List is empty.

Parent/Guardian Information

Parent/Guardian First Name *

Parent/Guardian Last Name *

Phone *

Email *

What is your relationship to the student being considered for the Aviation Program? *

Parent
Guardian
Friend
Other
No elements found. Consider changing the search query.
List is empty.

Acknowledgements & Consent

In-Person Participation *

I understand that this program is an in-person program and requires that participants be able to attend two in-person sessions per month. In-person sessions will last for 2 hours and will be held on the second or fourth Saturday of the month.

Electronic Confirmation *

BY ACKNOWLEDGING AND SUBMITTING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Photo Release *

I hereby give permission for my child to be photographed during their participation in the programs sponsored by the Alexandria-Fairfax (VA) Alumni Chapter of Kappa Alpha Psi, Inc. Fraternity. Inc. I understand the photos will be used to keep a journal of activities, to share during powerpoint presentations and/or reports to our donors and for promotional purposes including flyers, brochures, newspapers and on the internet. I understand that although my child’s photograph may be used for advertising, his or her identity will not be disclosed, I do not expect compensation and that all photos are the property of Alexandria-Fairfax (VA) Alumni Chapter of Kappa Alpha Psi, Inc.