Check Ride Intake Sheet 2022
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!
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Email *
1.  Check Ride Type *
2.  If Part 141, Include Date on Graduation Certificate
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3.  Certificate or Rating Sought (Check Ride) *
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 *
Required
9.  CFI Endorsement / IACRA Completion Date
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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)
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14.  Knowledge Exam Grade  (If applicable) *
15.  Flight Training Facility *
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 *
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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. *
22.  Notice of Disapproval Date (if Retest)
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23.  If not me, list the DPE’s Name, Location - City and State (If Notice of Disapproval)
24.  Letter of Discontinuance *
25.  Letter of Discontinuance Date (If Letter of Discontinuance)
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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 *
29.  iPad Database Current *
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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