Flight Test Request Form – FAA Pilot Testing

Do Not submit this form until you have spoken to me. 914 525 9431

After the Fees and Policies page has been read and a date is set fill in the form below:

The information you provide on this form goes to the FAA and gives me authorization to conduct the practical test. Incorrect or incomplete information may cause your check ride to be delayed or cancelled.

Items marked * are required by the FAA. They must be accurate.

It is strongly recommended that you read the “Guide to making your test go smoothly”

Call or text 914-525-9431 after form is submitted

Full Name: *

Full name (Including middle name) as it appears on your pilots certificate

Your Certificate Number (Do not leave blank) *

FTN: (Do not leave blank. Do not enter NA) *

Email: *

Phone number: *

(xxx) xxx-xxxx

Certificate or Rating applied for on the basis of: *

Aircraft category sought - Airplane or Glider *

Airplane Single Engine Land
Glider
None (Administrative)

Type of Practical Test or Check *

Grade of Certificate that is sought in the test *

Type of Certificate now held: *

CFI Ratings Held: *

If CFI rating sought:

Aircraft Make and Model: Use same aircraft designation as IACRA 8710-1 Section II Block (A)(1) *

Example: CE-172-R or PA-18-161 https://www.faa.gov/documentlibrary/media/form/faa_8710-1.pdf

N Number of aircraft being used for test: *

Proposed location of test (Airport and flight school are required): *

Proposed date of test: *

xx/xx/xxxx (8 digit date)

Grade earned on knowledge test *

Recommending Instructor (Type NA if None): *

Certificate number of Recommending Instructor: (Do not leave blank) *

Email address of Recommending Instructor: *

Phone number of Recommending Instructor: *

(xxx) xxx-xxxx

Have you previously failed a test for this rating?: *

Have you read the Fees and Policies Page and the Guide to Making Your Test Go Smoothly? *

Your Residential Address *

Not a PO Box

City, State, Zip code *

Do not omit State and Zip code

Address of Airport where training was done *

Name of Flight School, Address, City, State, Zip Code

If this a part 141 Check enter School Name and School ID Number

Use the Part 141 number of your school Example: K99S999Y

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