Check Ride Intake Sheet 2022

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Do not complete unless you have scheduled your Check Ride with me. If you have, please fill out this form to make your Check Ride process more efficient. Administrative Functions - Check "NO" if it does not apply to you. Use the email that it sends you to keep your information updated. Read carefully & provide the information requested. Thank you!

Email *

1. Check Ride Type *

Part 61

Part 141

Administrative Examiner (Military Competency, Removal of SOE & SIC, Foreign Pilot, & Remote Pilot)

2. If Part 141, Include Date on Graduation Certificate

YYYY

3. Certificate or Rating Sought (Check Ride) *

Private

Instrument Rating

Commercial Single

Multi-Engine

Multi-Commercial

ATP

Flight Instructor

Ground Instructor

Administrative Examiner (Military Competency, Removal of SOE & SIC, Foreign Pilot, & Remote Pilot) See Below.

Other:

4.a. For Administrative Only - Describe what Certificates or Ratings you are seeking? If a type rating for a military aircraft, specify military make and model.

4.b. Acceptable Military Records

5. For Flight Instructors Only - Is this your "Initial" "Renewal" or an "Add-on"?

Application Information

6. Name (Last, First, Middle) *

7. List your current type of Certificates/Ratings held (Includes Student Pilot Certificate). Please include your Pilot/Student Pilot Certificate number as applicable. *

8. CFI Endorsement & IACRA Completed *

Yes

Required

9. CFI Endorsement / IACRA Completion Date

YYYY

10. Current Address, to include Street Address, City, State, & Zip Code *

11. Phone (home or cell) *

12. List "BOTH" IACRA FTN & Application ID (Located on the bottom right side of the 8710) *

13. Knowledge Exam Date (If applicable, otherwise put N/A)

YYYY

14. Knowledge Exam Grade (If applicable) *

15. Flight Training Facility *

SkyWarrior

Aircraft Management Services (AMS)

Pensacola Air

Flight Training Mobile

Aeropro

Independent Flight Instructor (Add Location under "Other")

ACOM Aviation Academy LLC

Precision Flight Training

Other:

16. Training Facility (if Other, Include Address, City, State, & Zip Code)

Instructor Information

1 7. Instructor's Name (Last, First) *

18. Instructor Phone (home or cell) *

19. Instructor's CFI Certificate Number & E-Mail *

Practical Test (Check Ride) Information

20. Requested Date *

YYYY

21. Retest (If "YES", Complete a new IACRA 8710 and get your Instructors to Retrain and Endorse you for the Retest. Also, complete a new Check Ride Intake Sheet for me. *

Yes

22. Notice of Disapproval Date (if Retest)

YYYY

23. If not me, list the DPE’s Name, Location - City and State (If Notice of Disapproval)

24. Letter of Discontinuance *

Yes

25. Letter of Discontinuance Date (If Letter of Discontinuance)

YYYY

26. If not me, list the DPE's Name, Location - City and State (If Letter of Discontinuance)

27. Aircraft to be used (Make, Model & "N" number): *

28. GPS Database Current *

Yes

29. iPad Database Current *

Yes

30. Location for Check Ride (Airport's 3 Letter ID) and Include Cross Country (If applicable) after I assign it. Also, include the time we agreed to meet. *

A copy of your responses will be emailed to the address you provided.

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