PILOT PROFICIENCY AWARD PROGRAM "WINGS"

"SEAWINGS"

Pilot Information

  All information must be included to process this application

(Please Print or Type)

 

 

NAME ______________________________________________________________________________

 

 

ADDRESS ___________________________________________________________________________ CITY_______________________________STATE __________ZIP CODE _______________________

 

 

TELEPHONE NUMBER____________________CERTIFICATE NUMBER #___________________

 

 

GRADE OF PILOT CERTIFICATE______________________

 

Eligible For Phase: I II III IV V VI VII VIII IX X XI XII XIII XIV XV XVI XVII XVIII XIX XX (Circle One)

If applying for Wings IV awards or above, please include a copy of your previous award.

Record of Recurrent Training

Safety Program Attended:_(Title)______________________________________________________

Location__________________________________________________Date____________________

Name & Signature of SPM, ASPM or ASC) _____________________________________________

Flight Training As Per Advisory Circular AC 61-91H

......................Date ................................CFI's Signature .....................CFI Cert. # .............Expires...........

Hour #1 _______________ _____________________________ ________________ ________________

Hour #2 _______________ _____________________________ ________________ ________________

Hour #3 _______________ _____________________________ ________________ ________________

Recommending CFI's Name: _______________________ Date:____________(Please Print or Type)

revised 08/01