TSA Citizenship Verification I certify that (First name, MI, Last name) _____________________________________ has presented me a _____________________________________ establishing that he or she is a U.S. Citizen or national in accordance with 49 CFR 1552.3(h) Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Pre-solo aeronautical knowledge: section 61.87(b). I certify that (First name, MI, Last name) _____________________________________ has satisfactorily completed the pre-solo knowledge exam of section 61.87(b) for the (make and model)_____________________________________ aircraft. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Pre-solo flight training: section 61.87(c). I certify that (First name, MI, Last name) _____________________________________ has received the required pre-solo training in a (make and model) _____________________________________ aircraft. I have determined He/She has demonstrated the proficiency of section 61.87 (* Sections d-m as appropriate) and is proficient to make solo flights in (make and model) _____________________________________ aircraft. *Choose appropriate section for insertion: (d) single-engine land (e) multi-engine land (f) helicopter (g) gyroplane (h) powered-lift (i) glider (j) airship (k) balloon (l) powered parachute (m) weight-shift control aircraft Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Pre-solo flight training at night: section 61.87(c) and (o). I certify that (First name, MI, Last name) _____________________________________ has received the required pre-solo training in a (make and model) _____________________________________ aircraft. I have determined He/She has demonstrated the proficiency of section 61.87 (* Sections d-m as appropriate) and is proficient to make solo flights at night in a (make and model)_____________________________________ aircraft. *Choose appropriate section for insertion: (d) single-engine land (e) multi-engine land (f) helicopter (g) gyroplane(h) powered-lift (i) glider (j) airship (k) balloon (l) powered parachute (m) weight-shift control aircraft Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Solo flight (each additional 90-day period): section 61.87(n). I certify that (First name, MI, Last name) _____________________________________ has received the required training to qualify for solo flying. I have determined He/She meets the applicable requirements of section 61.87(n) and is proficient to make solo flights in (make and model)_____________________________________ aircraft. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Solo takeoffs and landings at another airport within 25 nm: section 61.93(b)(1). I certify that (First name, MI, Last name) _____________________________________ has received the required training of section 61.93(b)(1). I have determined that He/She is proficient to practice solo takeoffs and landings at (airport name). The takeoffs and landings at (airport name) _____________________________________ are subject to the following conditions: (conditions or limitations) _____________________________________. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Initial solo cross-country flight: section 61.93(c)(1). I certify that (First name, MI, Last name) _____________________________________ has received the required solo cross-country training. I find He/She has met the applicable requirements of section 61.93(* Sections d-m as appropriate), and is proficient to make solo cross-country flights in a (make and model) _____________________________________ aircraft. *Choose appropriate section for insertion: (e) single-engine land (f) multi-engine land (g) helicopter (h) gyroplane(i) powered-lift (j) glider (k) airship (l) powered parachute (m) weight-shift control aircraft Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Solo cross-country flight: section 61.93(c)(2). I have reviewed the cross-country planning of (First name, MI, Last name)_____________________________________ . I find the planning and preparation to be correct to make the solo flight from (location) _____________________________________ to (destination) _____________________________________ via (route of flight) _____________________________________ with landings at (name the airports) _____________________________________ in a (make and model)_____________________________________ aircraft on (date)_____________________________________. (conditions or limitations) _____________________________________. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Repeated solo cross-country flights not more than 50 nm from the point of departure: section 61.93(b)(2). I certify that (First name, MI, Last name) _____________________________________ has received the required training in both directions between and at both (airport names)_____________________________________ . I have determined that He/She is proficient of section 61.93(b)(2) to conduct repeated solo cross-country flights over that route, subject to the following conditions: (conditions or limitations) _____________________________________. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Solo flight in Class B airspace: section 61.95(a). I certify that (First name, MI, Last name) _____________________________________ has received the required training of section 61.95(a). I have determined He/She is proficient to conduct solo flights in (name of Class B) _____________________________________ airspace. (conditions or limitations) _____________________________________. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Solo flight to, from, or at an airport located in Class B airspace: section 61.95(a) and section 91.131(b)(1). I certify that (First name, MI, Last name) _____________________________________ has received the required training of section 61.95(a)(1). I have determined that He/She is proficient to conduct solo flight operations at (name of airport)_____________________________________. (conditions or limitations) _____________________________________. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Written Test: Aeronautical knowledge test: sections 61.35(a)(1), 61.103(d), and 61.105 I certify that (First name, MI, Last name) _____________________________________ has received the required training in accordance with section 61.105. I have determined He/She is prepared for the Private Pilot Knowledge Test. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Flight Test: Private Pilot Aeronautical Knowledge: section 61.105 I certify that (First name, MI, Last name) _____________________________________ has received the required training in accordance with section 61.105 and that He/She is prepared for the Private Pilot Practical Test. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Flight proficiency/practical test: sections 61.103(f), 61.107(b), and 61.109 I certify that (First name, MI, Last name) _____________________________________ has received the required training in accordance with sections 61.107(b) (* Sections 1-10 as appropriate) and 61.109. I have determined He/She is prepared for the Private Pilot Practical Test. *Choose appropriate section for insertion: (1) single-engine land (2) multi-engine land (3) helicopter (4) gyroplane (5) powered-lift (6) glider (7) airship (8) balloon (9) powered parachute (10) weight-shift control aircraft Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Prerequisites for Practical Tests: section 61.39(a) I certify that (First name, MI, Last name) _____________________________________ has received the training as required by section 61.39(a)(6)(i) within the preceding two calendar months and have determined that he/she is prepared for the Private Pilot practical test. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Prerequisites for Practical Tests: section 61.39(a) I certify that (First name, MI, Last name) _____________________________________ has demonstrated satisfactory knowledge of subject areas shown to be deficient on his/her Private Pilot Airman’s Knowledge Test as required by 61.39(a)(6)(iii). Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Written Test: Aeronautical knowledge test: section 61.35(a)(1), section 61.123(c), and section 61.125 I certify that (First name, MI, Last name) _____________________________________ has received the required training of section 61.125. I have determined that He/She is prepared for the Commercial Pilot aeronautical knowledge test. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Flight Test: Flight proficiency/practical test: section 61.123(e), section 61.127, and section 61.129 I certify that (First name, MI, Last name) _____________________________________ has received the required training of section 61.127 (b) (* Sections 1-8 as appropriate) and section 61.129. I have determined He/She is prepared for the Commercial Pilot Practical test. *Choose appropriate section for insertion: (1) single-engine land (2) multi-engine land (3) helicopter (4) gyroplane(5) powered-lift (6) glider (7) airship (8) balloon Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Prerequisites for Practical Tests: section 61.39(a) I certify that (First name, MI, Last name) _____________________________________ has received the training as required by section 61.39(a)(6)(i) within the preceding two calendar months and have determined that he/she is prepared for the Commercial Pilot practical test. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Prerequisites for Practical Tests: section 61.39(a) I certify that (First name, MI, Last name) _____________________________________ has demonstrated satisfactory knowledge of subject areas shown to be deficient on his/her Commercial Pilot Airman’s Knowledge Test as required by 61.39(a)(6)(iii). Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Written Test: Aeronautical knowledge test: section 61.35(a)(1) and section 61.65(a) and (b) I certify that (First name, MI, Last name) _____________________________________ has received the required training of section 61.65(b). I have determined that He/She is prepared for the Instrument Pilot Rating knowledge test. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Flight Test: Aeronautical Knowledge/Flight proficiency/practical test: section 61.65(a) I certify that (First name, MI, Last name) _____________________________________ has received the required training of section 61.65(b)(c) and (d). I have determined He/She is prepared for the Instrument—airplane practical test. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Prerequisites for Practical Tests: section 61.39(a) I certify that (First name, MI, Last name) _____________________________________ has received the training as required by section 61.39(a)(6)(i) within the preceding two calendar months and have determined that he/she is prepared for the Instrument Pilot practical test. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Prerequisites for Practical Tests: section 61.39(a) I certify that (First name, MI, Last name) _____________________________________ has demonstrated satisfactory knowledge of subject areas shown to be deficient on his/her Instrument Pilot Airman’s Knowledge Test as required by 61.39(a)(6)(iii). Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Flight Test: Fundamentals of instructing knowledge test: section 61.183(d) and section 61.185(a)(1) and (a)(2) I certify that (First name, MI, Last name) _____________________________________ has received the required fundamentals of instruction training of sections 61.183 and 61.185(a)(1) and (a)(2). Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Flight instructor ground and flight proficiency/practical test: section 61.183(g) and section 61.187(a) and (b) I certify that (First name, MI, Last name) _____________________________________ has received the required training of section 61.187(b)(* Section as appropriate). I have determined He/She is prepared for the CFI (aircraft category and class) practical test. *Choose appropriate section for insertion: (1) Airplane single-engine (2) Airplane multi-engine (3) Rotorcraft helicopter (4)Rotorcraft gyroplane (5) Powered lift (6) Glider (7) Instrument instructor Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Prerequisites for Practical Tests: section 61.39(a) I certify that (First name, MI, Last name) _____________________________________ has received the training as required by section 61.39(a)(6)(i) within the preceding two calendar months and have determined that he/she is prepared for the Flight Instructor practical test. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Prerequisites for Practical Tests: section 61.39(a) I certify that (First name, MI, Last name) _____________________________________ has demonstrated satisfactory knowledge of subject areas shown to be deficient on his/her Flight Instructor Airman’s and Fundamentals of Instruction Airman’s Knowledge Tests as required by 61.39(a)(6)(iii). Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Spin training: section 61.183(i)(1) I certify that (First name, MI, Last name) _____________________________________ has received the required training of section 61.183(i). I have determined that He/She is competent in instructional skills for training stall awareness, spin entry, spins, and spin recovery procedures. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Flight Test: Flight instructor certificate with instrument—(category/class) rating/practical test: section 61.183(g), section 61.185(a)(3) and section 61.187(a) and (b)(7) I certify that (First name, MI, Last name) _____________________________________ has received the required CFII training of section 61.185(a)(3) and section 61.187(b)(* Sections 1-7 as appropriate). I have determined he/she is prepared for the CFII (airplane, helicopter, or powered-lift) practical test. *Choose appropriate section for insertion: (1) Airplane single-engine (2) Airplane multi-engine (3) Rotorcraft helicopter (4)Rotorcraft gyroplane (5) Powered lift (6) Glider Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Prerequisites for Practical Tests: section 61.39(a) I certify that (First name, MI, Last name) _____________________________________ has received the training as required by section 61.39(a)(6)(i) within the preceding two calendar months and have determined that he/she is prepared for the Instrument Instructor practical test. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Prerequisites for Practical Tests: section 61.39(a) I certify that (First name, MI, Last name) _____________________________________ has demonstrated satisfactory knowledge of subject areas shown to be deficient on his/her Instrument Instructor Airman’s Knowledge Test as required by 61.39(a)(6)(iii). Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Flight Test: Additional Category/Class Rating: section 61.63(b)(c) I certify that (First name, MI, Last name) _____________________________________ has received the training as required by section 61.93(b)(c) and find Him/Her proficient to pass the (Private or Commercial) pilot practical test for the Airplane Multi-engine (Land or Sea) rating. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Prerequisites for Practical Tests: section 61.39(a) I certify that (First name, MI, Last name) _____________________________________ has received the training as required by section 61.39(a)(6)(i) within the preceding two calendar months and have determined that he/she is prepared for the Multi-Engine practical test. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Pre-solo aeronautical knowledge: section 61.87(b) I certify that (First name, MI, Last name) _____________________________________ has satisfactorily completed the pre-solo knowledge exam of section 61.87(b) for the (make and model aircraft)____________________________________. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Pre-solo flight training: section 61.87(c) I certify that (First name, MI, Last name) _____________________________________ has received the required pre-solo training in a (make and model aircraft)_____________________________________. I have determined He/She has demonstrated the proficiency of section 61.87 ((d) through (m), as appropriate) and is proficient to make solo flights in (aircraft category*: make and model aircraft). *Choose appropriate section for insertion: (d) single-engine land (e) multi-engine land (f) helicopter (g) gyroplane(h) powered-lift (i) glider (j) airship (k) balloon (l) powered parachute (m) weight-shift control aircraft Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Solo flight (additional 90-day period): section 61.87(n)(2) I certify that (First name, MI, Last name) _____________________________________ has received the required training to qualify for solo flying. I have determined He/She meets the applicable requirements of section 61.87(n) and is proficient to make solo flights in (make and model)_____________________________________. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Solo takeoffs and landings at another airport within 25 nm: section 61.93(b)(1) I certify that (First name, MI, Last name) _____________________________________ has received the required training of section 61.93(b)(1). I have determined that He/She is proficient to practice solo takeoffs and landings at (airport name) _____________________________________. The takeoffs and landings at (airport name) _____________________________________are subject to the following conditions: (List any applicable conditions or limitations) _____________________________________. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Initial solo cross-country flight training: section 61.93(c)(1) I certify that (First name, MI, Last name) _____________________________________ has received the required solo cross-country training. I find He/She has met the applicable requirements of section 61.93, and is proficient to make solo cross-country flights in a (make and model aircraft)_____________________________________. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Solo cross-country flight: section 61.93(c)(2) I have reviewed the cross-country planning of (First name, MI, Last name)_____________________________________. I find the planning and preparation to be correct to make the solo flight from (location) _____________________________________ to (destination) _____________________________________ via (route of flight) _____________________________________ with landings at (name the airports) _____________________________________ in a (make and model aircraft) _____________________________________ on (date)_____________________________________. (List any applicable conditions or limitations.) _____________________________________ Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Repeated solo cross-country flights not more than 50 nm from the point of departure: section 61.93(b)(2) I certify that (First name, MI, Last name) _____________________________________ has received the required training in both directions between and at both (airport names)_____________________________________. I have determined that He/She is proficient of section 61.93(b)(2) to conduct repeated solo cross-country flights over that route, subject to the following conditions: (List any applicable conditions or limitations) _____________________________________ Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Solo flight in Class B, C, and D airspace: section 61.94(a) I certify that (First name, MI, Last name) _____________________________________ has received the required training of section 61.94(a) (Include “and section 91.131” if being used for Class B airspace). I have determined He/She is proficient to conduct solo flights in (name of Class B, C, or D) _____________________________________ airspace and authorized to operate to, from through and at _____________________________________ airport. (List any applicable conditions or limitations) _____________________________________ Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Solo flight to, from, or at an airport located in Class B, C, or D airspace or on an airport having an operational control tower: section 61.94(a) and section 91.131(b)(1) I certify that (First name, MI, Last name) _____________________________________ has received the required training of section 61.94(a)(1) (Include “and section 91.131” if being used for Class B airspace). I have determined that He/She is proficient to conduct solo flight operations at (name of airport) _____________________________________ located in Class B, C, or D airspace or on an airport having an operational control tower. (List any applicable conditions or limitations) _____________________________________ Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Pre-solo flight training at night: section 61.87(c) and (o) I certify that (First name, MI, Last name) _____________________________________ has received the required pre-solo training in a (make and model aircraft) _____________________________________ and determined He/She has demonstrated the proficiency of section 61.87(o) and is proficient to make solo flights at night in a (make and model aircraft)_____________________________________. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Written Test: Taking aeronautical knowledge test: section 61.35(a)(1) and section 61.309 I certify that (First name, MI, Last name) _____________________________________ has received the required aeronautical knowledge training of section 61.309. I have determined that He/She is prepared for the (name the knowledge test) _____________________________________. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Flight Test: Taking sport pilot practical test: section 61.309, section 61.311, and section 61.313 I certify that (First name, MI, Last name) _____________________________________ has received the training required in accordance with section 61.309 and section 61.311 and met the aeronautical experience requirements of section 61.313. I have determined that he/she is prepared for the (type of practical test) _____________________________________ . Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Passing a sport pilot practical test: section 61.309, section 61.311, and section 61.313. NOTE: Required by section 61.317, issued by a designated pilot examiner (DPE) I certify that (First name, MI, Last name) _____________________________________ has met the requirements of section 61.309, section 61.311, and section 61.313, and I have determined Him/Her proficient to act as PIC of (category and class of light sport aircraft) _____________________________________ aircraft. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Prerequisites for Practical Tests: section 61.39(a) I certify that (First name, MI, Last name) _____________________________________ has received the training as required by section 61.39(a)(6)(i) within the preceding two calendar months and have determined that he/she is prepared for the Sport Pilot practical test. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Prerequisites for Practical Tests: section 61.39(a) I certify that (First name, MI, Last name) _____________________________________ has demonstrated satisfactory knowledge of subject areas shown to be deficient on his/her Sport Pilot Airman’s Knowledge Test as required by 61.39(a)(6)(iii). Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Taking flight proficiency check for different category or class of aircraft: section 61.309 and section 61.311 I certify that (First name, MI, Last name) _____________________________________ has received the required training required in accordance with sections 61.309 and 61.311 and have determined that he/she is prepared for the (name the proficiency check)_____________________________________. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Passing flight proficiency check for different category or class of aircraft: section 61.309 and section 61.311 I certify that (First name, MI, Last name) _____________________________________ has met the requirements of sections 61.309 and 61.311 and I have determined him/her proficient to act as PIC of (category and class) _____________________________________ of light-sport aircraft. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Flight proficiency in same category and class within a different make and model of aircraft: section 61.323 I certify that (First name, MI, Last name) _____________________________________ has received the required training of section 61.323 in (make and model aircraft) _____________________________________ and have determined him/her proficient to act as PIC of that light-sport aircraft. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Class B, C, or D airspace, at an airport located in Class B, C, or D airspace, or to, from, through, or on an airport having an operational control tower: section 61.325 I certify that (First name, MI, Last name) _____________________________________ has received the required training of section 61.325. I have determined He/She is proficient to conduct operations in (List category of airspace approved, Class B, C, and/or D) _____________________________________ airspace, at an airport located in Class B, C, or D airspace, or to, from, through, or on an airport having an operational control tower. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Light-sport aircraft that has a VH greater than 87 knots CAS: section 61.327 I certify that (First name, MI, Last name) _____________________________________ has received the required training required in accordance with section 61.327 in a (make and model aircraft)_____________________________________. I have determined Him/Her proficient to act as PIC of a light-sport aircraft that has a VH greater than 87 knots (kts) CAS. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Written Test: Taking the fundamentals of instructing knowledge test: section 61.405(a)(1) I certify that (First name, MI, Last name) _____________________________________ has received the required training in accordance with section 61.405(a)(1). I have determined that He/She is prepared for the Fundamentals of Instruction Knowledge Test. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Taking sport pilot flight instructor aeronautical knowledge test: section 61.35(a) (1) and section 61.405(a) I certify that (First name, MI, Last name) _____________________________________ has received the required training of section 61.405(a)(2). I have determined that He/She is prepared for the Sport Pilot Knowledge Test. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Flight Test: Taking the flight instructor flight proficiency check to provide training if a different category or class of aircraft (additional category/class): section 61.419 and section 61.409 I certify that (First name, MI, Last name) _____________________________________ has received the required training in accordance with section 61.419 and section 61.409 and have determined He/She is prepared for a proficiency check for the flight instructor with a sport pilot rating in a (aircraft category and class)_____________________________________. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Passing the flight instructor flight proficiency check to provide training in a different category or class of aircraft (additional category/class): section 61.419 and section 61.409 I certify that (First name, MI, Last name) _____________________________________ has met the requirements in accordance with section 61.419 and section 61.409. I have determined that He/She is proficient and authorized for the additional (aircraft category and class) _____________________________________ flight instructor privilege. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Taking the flight instructor practical test: section 61.409 and section 61.411 I certify that (First name, MI, Last name) _____________________________________ has received the required training of section 61.409 and met the aeronautical experience requirements of section 61.411. I have determined He/She is prepared for the flight instructor with a sport pilot rating practical test in a (aircraft category and class)_____________________________________. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Passing the flight instructor practical test: section 61.409 and section 61.411. NOTE: Required by section 61.417, issued by a DPE I certify that (First name, MI, Last name) _____________________________________ has met the requirements in accordance with section 61.409 and section 61.411. I have determined that He/She is proficient and authorized for the (aircraft category and class) _____________________________________ flight instructor privilege. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Prerequisites for Practical Tests: section 61.39(a) I certify that (First name, MI, Last name) _____________________________________ has received the training as required by section 61.39(a)(6)(i) within the preceding two calendar months and have determined that he/she is prepared for the Sport Pilot Instructor practical test. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Prerequisites for Practical Tests: section 61.39(a) I certify that (First name, MI, Last name) _____________________________________ has demonstrated satisfactory knowledge of subject areas shown to be deficient on his/her Sport Pilot Instructor and Fundamentals of Instructing Airman’s Knowledge Tests as required by 61.39(a)(6)(iii). Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Spin training: section 61.405(b)(1)(ii) I certify that (First name, MI, Last name) _____________________________________ has received the required training of section 61.405(b)(1)(ii). I have determined that He/She is competent and possess instructional proficiency in stall awareness, spin entry, spins, and spin recovery procedures. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Ground instructor who does not meet the recent experience requirements: section 61.217(b) I certify that (First name, MI, Last name) _____________________________________ has demonstrated satisfactory proficiency on the appropriate ground instructor knowledge and training subjects of section 61.213(a)(3) and (a)(4). Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Written Test: Aeronautical knowledge test: section 61.35(a)(1), section 61.96(b)(3), and section 61.97(b) I certify that (First name, MI, Last name) _____________________________________ has received the required training of section 61.97(b) 1-12. I have determined that He/She is prepared for the Recreational Pilot Knowledge test. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Flight Test: Flight proficiency/practical test: section 61.96(b)(5), section 61.98(a) and (b), and section 61.99 I certify that (First name, MI, Last name) _____________________________________ has received the required training of section 61.98(b)1 and section 61.99. I have determined that He/She is prepared for the Recreational Pilot Practical test. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Prerequisites for Practical Tests: section 61.39(a) I certify that (First name, MI, Last name) _____________________________________ has received the training as required by section 61.39(a)(6)(i) within the preceding two calendar months and have determined that he/she is prepared for the Recreational Pilot practical test. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Prerequisites for Practical Tests: section 61.39(a) I certify that (First name, MI, Last name) _____________________________________ has demonstrated satisfactory knowledge of subject areas shown to be deficient on his/her Recreational Pilot Airman’s Knowledge Test as required by 61.39(a)(6)(iii). Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Recreational pilot to operate within 50 nm of the airport where training was received: section 61.101(b) I certify that (First name, MI, Last name) _____________________________________ has received the required training of section 61.101(b). I have determined He/She is competent to operate at the (name of airport)_____________________________________. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Recreational pilot to act as PIC on a flight that exceeds 50 nm of the departure airport: section 61.101(c) I certify that (First name, MI, Last name) _____________________________________ has received the required cross-country training of section 61.101(c). I have determined that He/She is proficient in cross-country flying of part 61, subpart E. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Recreational pilot with less than 400 flight hours and not logged PIC time within the preceding 180 days: section 61.101(g) I certify that (First name, MI, Last name) _____________________________________ has received the required 180-day recurrent training of section 61.101(g) in a (make and model aircraft)_____________________________________. I have determined Him/Her proficient to act as PIC of that aircraft. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Recreational pilot to conduct solo flights for the purpose of obtaining an additional certificate or rating while under the supervision of an authorized flight instructor: section 61.101(i) I certify that (First name, MI, Last name) _____________________________________ has received the required training of section 61.87 in a (make and model aircraft)_____________________________________. I have determined He/She is prepared to conduct a solo flight on (date)_____________________________________ under the following conditions: (List all conditions which require endorsement) _____________________________________ Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Class B, C, or D airspace, at an airport located in Class B, C, or D airspace, or to, from, through, or on an airport having an operational control tower: section 61.101(d) I certify that (First name, MI, Last name) _____________________________________ has received the required training of section 61.101(d). I have determined He/She is proficient to conduct operations in Class B, C, or D airspace, at an airport located in Class B, C, or D airspace, or to, from, through, or on an airport having an operational control tower. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

TSA Citizenship Verification Endorsement I certify that (First name, MI, Last name)_____________________________________ has presented me a _____________________________________ establishing that he or she is a U.S. Citizen or national in accordance with 49 CFR 1552.3(h) Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Completion of a flight review: section 61.56(a) and (c) I certify that (First name, MI, Last name)_____________________________________, (pilot certificate)_____________________________________, (certificate number)_____________________________________, has satisfactorily completed a flight review of section 61.56(a) on (date)_____________________________________. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Completion of an instrument proficiency check: section 61.57(d) I certify that (First name, MI, Last name)_____________________________________, (pilot certificate)_____________________________________, (certificate number)_____________________________________, has satisfactorily completed the instrument proficiency check of section 61.57(d) in a (list make and model of aircraft) _____________________________________ on (date)_____________________________________. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

To act as PIC in a complex airplane: section 61.31(e) I certify that (First name, MI, Last name)_____________________________________, (pilot certificate)_____________________________________, (certificate number)_____________________________________, has received the required training of section 61.31(e) in a (make and model of complex airplane)_____________________________________. I have determined that He/She is proficient in the operation and systems of a complex airplane. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

To act as PIC in a high performance airplane: section 61.31(f) I certify that (First name, MI, Last name)_____________________________________, (pilot certificate)_____________________________________, (certificate number)_____________________________________, has received the required training of section 61.31(f) in a (make and model of high performance airplane)_____________________________________. I have determined that He/She is proficient in the operation and systems of a high performance airplane. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

To act as PIC in a pressurized aircraft capable of high altitude operations: section 61.31(g) I certify that (First name, MI, Last name)_____________________________________, (pilot certificate)_____________________________________, (certificate number)_____________________________________, has received the required training of section 61.31(g) in a (make and model of pressurized aircraft)_____________________________________. I have determined that He/She is proficient in the operation and systems of a pressurized aircraft. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

To act as PIC in a tailwheel airplane: section 61.31(i) I certify that (First name, MI, Last name)_____________________________________, (pilot certificate)_____________________________________, (certificate number)_____________________________________, has received the required training of section 61.31(i) in a (make and model of tailwheel airplane)_____________________________________. I have determined that He/She is proficient in the operation of a tailwheel airplane. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

To act as PIC of an aircraft in solo operations when the pilot does not hold an appropriate category/class rating: section 61.31(d)(3) I certify that (First name, MI, Last name) _____________________________________ has received the training as required by section 61.31(d)(3) to serve as a PIC in a (category and class of aircraft)_____________________________________. I have determined that He/She is prepared to serve as PIC in that (make and model) _____________________________________ aircraft. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________

Retesting after failure of a knowledge or practical test: section 61.49 I certify that (First name, MI, Last name) _____________________________________ has received the additional (flight and/or ground, as appropriate) training as required by section 61.49. I have determined that He/She is prepared for the (name the knowledge/practical test)_____________________________________. Signed: ________________________________________ Date: ___________________ CFI No.: ____________________________________ Exp. Date: ___________________