Pilot Qualification Form
To help us better understand your background and flying experience, kindly complete all of the requested information.  Your responses will be kept confidential, and will only be used to determine your eligibility.
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Email *
PERSONAL INFORMATION
Name *
First and last name
Address *
Phone number *
Date of Birth *
MM
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DD
/
YYYY
Employer *
QUALIFICATIONS/BACKGROUND
Certificates/Ratings Held (check all that apply) *
Required
Medical Certificate *
Any medical restrictions/limitations? *
If Yes, please explain:
Have you had any aircraft incidents/accidents in the past 5 years? *
If Yes, please explain:
Have you been cited for violating any civil or military flight regulations? *
If Yes, please explain:
FLYING EXPERIENCE
Date of last Biannual Flight Review *
MM
/
DD
/
YYYY
Total hours logged in the last 12 months *
Total hours logged in the last 90 days *
Total hours logged in Airplane Single-Engine Land *
Hours logged in Airplane Single-Engine Land in the past 90 days *
Total hours logged in a Cirrus SR-22/SR-22T *
Have you completed Cirrus Advanced Transition Training? *
Do you have a high performance endorsement? *
SUMMARY
Notes
A copy of your responses will be emailed to the address you provided.
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