Check Ride Intake Sheet 2018
Please fill out this form to make your Check Ride process more efficient.
Email address *
Check Ride Type *
If Part 141, Include Date on Graduation Certificate
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Rating *
For Flight Instructors Only - Is this your "Initial" or an "Add-on"?
Your answer
Application Info
Current Certificates/Rating Held (Includes Student Pilot) Please include your Pilot Certificate number. *
Your answer
CFI Endorsement & IACRA Completed *
Required
CFI Endorsement / IACRA Completion Date
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DD
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YYYY
Name (Last, First, Middle) *
Your answer
Phone (home or cell) *
Your answer
IACRA FTN
Your answer
Knowledge Exam Date (If applicable)
MM
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DD
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YYYY
Knowledge Exam Grade (If applicable) *
Your answer
Flight Training Facility *
Training Facility (if Other)
Your answer
Instructor Information
Instructor Name (Last, First) *
Your answer
Instructor Phone (home or cell) *
Your answer
Instructor E-Mail *
Your answer
Practical Test (Check Ride) Information
Requested Date *
MM
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DD
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YYYY
Retest *
Notice of Disapproval Date (if Retest)
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DD
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YYYY
Location - City and State (If Notice of Disapproval)
Your answer
Letter of Discontinuance *
Letter of Discontinuance Date (If Letter of Discontinuance)
MM
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DD
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YYYY
DPE's Name, Location - City and State (If Letter of Discontinuance)
Your answer
Aircraft to be used (Make, Model & "N" number): *
Your answer
GPS Database Current *
iPad Database Current *
Location for Check Ride (Airport's 3 Letter ID) and Include Cross Country (If applicable) after I assign it. *
Your answer
A copy of your responses will be emailed to the address you provided.
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