Federal Aviation Administration, DOT

Pt. 60, App. C

Attachment 4 to Appendix C to Part 60-Figure C4B- Sample Letter, Request for Initial, Upgrade, or Reinstatement Evaluation
Attachment: FFS Information Form

INFORMATION
Aircraft Equipment:

Engine Type(s):

Flight Instrumentation:
EFIS D HUD D HGS D EFVS
0 TCAS 0 GPWS 0 Plain View
D GPS D FMS Type:
D WX Radar D Other:

Engine Instrumentation:

D EICAS D FADEC
0 Other:

D

Airport Models:
Circle to Land:
Visual Ground Segment

Section 2. Sunnlementarv Informatio.n
D POI D TCPM 0 Other: _ _

FAA Training Program Approval Authority:
Name:

Office:

T

Tel:

Fax:

I

..Section

Email:
'

.Section.

SectionSection.Section

.SectionSection

FSTD Scheduling Person:
Name:
Address 1:

Address 2

City:

State:

ZIP:

Email:

Tel:

Fax:

FSTD Technical Contact:
Name:
Address 1:

Address 2

City:

State:

ZIP:

Email:

Tel:

.Fax:

Section 3~

Trainin2, Testin2 and Checkiu2 Considerations

Area/Function/Maneuver

Requested

ID
D
D
D
D
D
D

Private Pilot- Training I Checks: ( 142)
Commercial Pilot - Training /Checks:(] 42)
Multi-Engine Rating- Training I Checks (142)
Instrument Rating -Training I Checks (142)
Type Rating -Training I Checks (135/1211142)
Proficiency Checks (13511211142)

 - 

409

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ER09MY08.042</GPH>

kpayne on VMOFRWIN702 with $$_JOB

CAT I: (RVR 2400/1800 ft. DH200 ft)

Remarks