The National Black Coalition of Federal

Aviation Employees
Eastern Long Island & New York Metro Chapter

Aviation Career Education {ACE}

Academy
Where:

Federal Aviation Administration Eastern Region Headquarters

1 Aviation Plaza, Jamaica, NY 11434

When:

Monday, April 6, 2015 - Friday, April 10, 2015

Time:

8:00 a.m. - 5:00 p.m.

Open to Grades: 9th, 10th, 11th & 12th

Aviation Career Education (ACE) Academy is a nationally recognized program co-sponsored
by the Federal Aviation Administration (FAA) and the National Black Coalition of Federal
Aviation Employees (NBCFAE) that has reached well over 100,000 students nationwide
spanning its thirty plus years.
The mission of an Aviation Career Education (ACE) Academy is to offer middle and high
school students first level exposure to the aviation industry by providing aviation career
exploration. Academy participants learn about aviation history, theory of flight, and other
aviation related subjects.
The goal is to provide an exciting opportunity for students to learn about aviation
history, planning a flight, the physics of flight, and the design and maintenance of aircraft, the
role of government in aviation, and the many careers available in the aviation industry.
The ACE Academy is selective and requires submission of a "completed application" package
by March 25th, 2015.
Due to the fact that space is limited, please enroll early.
Registration fee: $ 50.00

For more information contact:

Derrick Michael at 516-683-2826
Tracy Montgomery at 631-468-1262
Or Email us at

Thomas Fleming at 516-658-9155

Donna Ann Harze at 718-553-3368

ELICHAPTER@GMAIL.COM .

Please put ACE REGISTRATION in the subject line.

NBCFAE Aviation Careers Education ACADEMY

2015 APPLICATION FORM
Date____________________________________
Name
Last Name

Name of Current
Middle/High School
*U.S. Citizen?

First Name

Birth Date

Grade
Gender

Ethnic Background

*Please note that some of the facilities we will be visiting require US Citizenship for entry.

Address
Street Address

City, State

Zip Code

Telephone
Home

Cell

Parent/Guardian
Last Name

First Name

Telephone
Cell

Work

Home

Medical Release - AUTHORIZATION AND CONSENT OF PARENT(S) OR LEGAL GUARDIAN(S)

As custodian of the aforementioned minor, I grant my authorization and consent for a designated adult to
administer general first aid treatment for minor injuries or illnesses. If the injury or illness is severe, I authorize
him or her to seek professional emergency personnel to attend, transport, and treat the minor and to issue
consent for any medical care deemed advisable by a licensed medical professional or institution. I authorize the
designated adult to exercise best judgment upon the advice of medical or emergency personnel.
Guardian
Signature
Primary Care
Physicians Name
Medical Insurance
Provider
Primary Member
Name
Allergies (including
to any Medications)
Prescription Drugs
the minor is taking
Other pertinent
medical information

Date

Phone #:
Group #
Policy/ID #
Medical / Physical
Conditions for which
the minor is receiving
treatment

Photo Use Release - AUTHORIZATION AND CONSENT OF PARENT(S) OR LEGAL GUARDIAN(S)

As custodian of the aforementioned minor, I grant my authorization and consent authorized the NBCFAE the
right to take, edit alter, copy, exhibit, publish, distribute and making use of any and all pictures or videos taken
of me and or my child to be used in and/or for legally promotional materials including, but not limited to
newsletter, flyers, posters, brochures, advertisement, fundraising letter, annual reports, press kits and
submissions to journalist, websites, social networking site and other print and digital communications, without
payment or any other consideration. This authorization shall continue indefinitely, unless I otherwise revoke
said authorization in writing.
I understand and agree that these materials shall become property of the NBCFAE and will not be returned.
I hereby hold harmless, and release in NBCFAE from all liabilities, petitions, and causes of action which I my
heirs, representatives, executors, administrators or any other person may make while acting on my behalf or on
the half of my estate.
If the person signing is under the age of consent, this release must be signed by a parent or guardian as follows:
I hereby certify that I am the parent or guardian of the above mentioned minor and do here by give my consent
without reservation to the foregoing on behalf of this individual.
Guardian
Signature

Date

Why would you like to attend the ACE Academy, and how do you think it will benefit you?
Please write a brief paragraph in the space provided or attach a separate sheet of paper.

QUALIFICATIONS/REQUIREMENTS
Admission to the ACE Academy is both competitive and selective. Applications must be complete,
including the medical and photo consent form. Complete applications are to be returned to NBCFAE by

March 25th, 2015.

Please complete the application form and email form to

ELICHAPTER@GMAIL.COM
Please put ACE REGISTRATION in the subject line.