Check Ride Request
Rusty Henderson DPE
NEW EMAIl
479 651 1919
Which Test ?
Private
Commercial
Instrument
Certified Flight Instructor
Location:_________________________Date/Time: __________________
Applicant
Name: ___________________________________Phone: ________________________
Email: _____________________________________ FTN Number: ___________________
Required documents (as applicable, and current)?
Pilot Certificate Number: ____________________
Medical/Basic Med Documentation (Y/N): ______
Photo ID (Y/N): ______
Knowledge Test(s) (Y/N): ______
Endorsements (Y/N): ______
IACRA/App signed by the instructor (Y/N): ______
Instructor
Name: __________________________________________________________________
Phone Number: ______________________ Email: _______________________________
Aircraft(s)
Make/Model: _____________________________ ’N’ Number: ______________________
Please have IACRA completed, and this form returned no later than 48 hours prior to the scheduled test.