PILOT PROFICIENCY AWARD PROGRAM "WINGS"

APPLICATION

Pilot Information

All information must be included to process this application

(Please Print or Type)

 

NAME ______________________________________________________________________________ ADDRESS____________________________________________________________________________ CITY__________________________STATE____________________ ZIP Code_____________________

TELEPHONE NUMBER ______________________________ Fax 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 0ne)

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

Record of Recurrent Training

Safety Program Attended: Location _________________________________________________Date_________________________

 

Print 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