Basic Flight Instructor Application

Applicant

Application Type

Basic Flight Instructor (BFI) $100.00 per 1 year Advanced Flight Instructor (AFI) $100.00 per 1 year

Applicant Name **

Address **

City **

State **

Zip **

Phone (H) **

Phone (W)

E-mail

ASC Membership # ** (B_ — TBD)

Date of Birth **

Sex **

Male Female

Background Summary

Total Time Ultralight ** (35 hours minimum)

Total Dual UL Received ** (10 hours minimum)

The total dual UL received is part of total UL time above and broken down between air and ground below.

Ground Dual UL Received **

Air Dual UL Received ** (minimum 3 hours)

Do you currently hold a two-place training exemption? If so, with whom?

What FAA certificates do you hold, if any?

FAA CFI #

UL Types Rated/Active In **

To Be Completed by Applicant **

Certification of Medical Status and Compliance

I hereby certify that I have no known medical condition or physical defect, which would make my operation of an ultralight vehicle unsafe. I also certify that should such a condition come to my knowledge, I will not operate an ultralight vehicle until such time as the condition is no longer a factor.

Signature of Applicant **

Date **

To Be Completed by Ultralight Flight Instructor (BFI) **

Certification of Instruction and Referral by Basic Flight Instructor

I have given, or reviewed, the above applicants flight instruction experience and training appropriate for Basic Flight Instructor. I hereby recommend the applicant for Basic Flight Instructor.

Instructor's Name (print) **

Membership # **

Instructor's Signature **

Date

To Be Completed by Advanced Flight Instructor (AFI) **

Certification of Instruction and Referral by Basic Flight Instructor

I have given, or reviewed, the above applicant's flight instruction experience and training appropriate for Basic Flight Instructor. I hereby recommend the applicant for Basic Flight Instructor.

Instructor's Name (print) **

Membership # **

Instructor's Signature **

Date **

Available Detailed Ratings

PHG3 approved by

PPG3 approved by

Complete the applicant section, then print for the required instructor signatures.