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DPE Practical Test Request

Current Authorizations:
Sport
Private ASEL
Military Competency
Advanced Ground Instructor

Email

info@mysite.com

Full Name (First Last)

Email

Phone

Practical Test or Function Requested *

Sport Pilot

Private Pilot

Military Competency

Ground Instructor

Current Pilot Certificate Number

FTN

IACRA Application Number

CFI Name, Cell Number, and Certificate Number

Aircraft for Practical Test (Make, Model, N Number)

Is Aircraft used for Practical Test:

Tailwheel

High-Performance

Desired Airport(s) for Practical Test

Regarding THIS Certificate Application:

This is my first attempt

Last attempt was a discontinuance

Last attempt was a disapproval

What do you plan on doing with your new certificate? Please share any additional information about you.

With respect to both of our schedules, please be completely sure both you, the airman, and your aircraft are fully qualified and eligible for the certificate sought.
References: § 61.109(a), § 91 Subpart E

Email a copy of any Letter of Discontinuance
and/or Notice of Disapproval, if applicable, to
dpemark@gmail.com

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Form Submitted!

"A safe pilot is always learning!"

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