Pt. 60, App. D

14 CFR Ch. I (1-1-19 Edition)

Attachment 4 to Appendix D to Part 60Figure D4F- Sample Statement of Qualification- Configuration List
INFORMATION
Visual System Manufacturer
and Type:
Engine Type(s):

Aircraft Equipment:

Motion System Manufacturer
and Type:

FSTD Seats
Available:

Flight Instrumentation:

Engine Instrumentation:

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

D EICAS D FADEC
0 Other:

Airport Models:
Circle to Land:
Visual Ground Segment

Section 2. Suple)~

tion

FAA Training Program Approval Authority:

v

Name:

Office:

Tel:

Fax:

. 1.....1

Email:

..._,..

..

M 0 Other:

I
I

FSTD Scheduling Person:
Name:
Address l:

Address 2

City:

State:

ZIP:

Email:

Tel:

Fax:

...
FSTD Technical Contact:
Name:
Address 1:

Address 2

City:

State:

ZIP:

Email:

Tel:

Fax:

..
Se~tion

3. Ttainin2:, Testin2:and Cbeckine: Considerations

Area/Function/Maneuver

Requested

Private Pilot- Training I Checks: (I 42)

D
D

Commercial Pilot- Training /Checks:(l42)
Multi-Engine Rating- Training I Checks ( 142)

0

Instrument Rating -Training I Checks (142)

D
D
D

Type Rating -Training I Checks (135/121/142)

-

-=== - 

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kpayne on VMOFRWIN702 with $$_JOB

Proficiency Checks (1351121/142)

Remarks