Applicants Full Name _________________________________
Type of Test Requested _________________________________
Certificate Number _____________________________________
Phone Number ________________________________________
Email Address ________________________________________
FTN number __________________________________________
Recommending Instructor _______________________________
Certificate Number _____________________________________
Phone Number ________________________________________
Email Address _________________________________________
Airport/Flight School ____________________________________
Part 61 or 141 _________________________________________
Aircraft to be used (Make/Model/N number) ___________________
Date requested _________________________________________
Morning or Afternoon? ____________________________________
(You must be signed off and in IACRA prior to completing this form) This form
must be complete for me to enter required data to obtain an FAA approval for the test.
When completed please forward this form to martin@haski.com