License Application

0619
United States Parachute Association®

| APPLICANT | | SKILL TABLES |

(Please type or print.) Change address on file Fill in the number of the highest license you
Name _________________________________________________________________________
DIEGO GERMAN VEGA currently hold and all the information requested
for each license that is higher than the one you
currently hold, up to and including the license
Street Address ___________________________________________________________________
CHALOUPKY 12
you are applying for. For each license requirement
met, write in either the number of the jump, the
______________________________________________________________________________ date of the training or the score, accordingly. The
verifying official must initial each block of the
City __________________________
KLATOVY State __________________________Zip
PILSEN ______________
33901
skill verification table and sign the verification
box. Refer to the Skydiver’s Information Manual,
Country ______________________________________________________
CZECH REPUBLIC
DOB___ / ___ /___ Section 3, for specific requirements.
DIEGOVEGA_14@HOTMAIL.COM
Email _________________________________________________________________________
By submitting this application for processing, I acknowledge that my privacy settings for sharing my personal information with
third parties, in Parachutist and in public lists at uspa.org are to be maintained by myself in my USPA account at uspa.org.
A #______________ LICENSE Number

If applying for an A-license, provide a photocopy

USPA # of a completed USPA A-License Application,
X __________________________________________ signed by a USPA Instructor, Instructor Examiner
Signature of Applicant or member of the USPA Board of Directors.

1838
| EXPERIENCE |
(Fill in both categories)
19:47
B #______________
Requirements
LICENSE Number
(or fill out below)

Jump No. or date Initial

Total Jumps __________________ Total Freefall Time (hours:minutes) _________________
Accuracy (10 jumps)

Formations (10)
| KNOWLEDGE | Water Training

A USPA Instructor administers the written exam(s) (B, C, and D licenses), records the passing score(s) in Canopy Course (See SIM 3-1)
the skill table(s), and initials the box(es). Exam Score

| VERIFICATION |
» License applications must be signed by a verifying official.
» Applications for B and C licenses may be signed by any current USPA Instructor. D-license applica-
C #______________
Requirements
LICENSE Number
(or fill out below)

Jump No. or date Initial

tions require the signature of a member of the USPA Board of Directors, a Safety & Training Advisor
or an Instructor Examiner. Accuracy (25 jumps)

I certify that I have personally checked the applicant’s logbook(s) and found documentation that the applicant Formations (50)
has met all applicable requirements as specified in the Skydiver’s Information Manual, Section 3-1.
BOD Exam Score
S&TA
IE

Name of verifying official (Print legibly.) Membership number (Please print or type)
Instructor
D NOTE: D LICENSE REQUIRES
SIGNATURE OF S&TA OR HIGHER.

Requirements Jump No. or date Initial

1 2
Night Jumps
Signature of verifying official Date
Exam Score

| PAYMENT |
Type $________License Fee ($36 each license) U.S. Foreign
B $________Expedite with email confirmation (add $20) American Express
C $________Total Discover

D X _____________________________________________ Mastercard
Submit via: Card Holder Signature Visa
Mail: USPA, 5401 Southpoint Centre Blvd. Fredericksburg, VA 22407. (Do not send original, please send photocopy.)
Check or Money Order
Email: safety@uspa.org
(payable to USPA)
Fax: (540) 604-9741 (Please call (540) 604-9740 to confirm transmission was received and legible.)
Do not send credit card information via email.

4. 6. 0. 3. 3. 2. 1. 0. 4. 4. 6. 5. 4. 8. 0. 7 0. 1. 1. 0. 5. 2. 1
CARD NUMBER (Visa, MasterCard, Discover and American Express) SECURITY CODE EXP. DATE (MMYY)
 License Exam Answer Sheet

0619
United States Parachute Association®

| APPLICANT |
(Please type or print.) A B C D
DIEGO GERMAN VEGA 24 07 19 1. D 26. D 1. B 1. B 1. 26.
Name ____________________________________ Date ___ / ___ /___
USPA # 2. C 27. B 2. B 2. B 2. 27.
X ________________________________
Signature of Applicant 3. B 28. B 3. A 3. B 3. 28.

4. D 29. D 4. A 4. C 4. 29.
| APPLICATION CHECKLIST |
5. B 30. B 5. D 5. D 5. 30.
The verifying official signing the license application should double check that
each of these items has been completed: 6. 31. 6. 6. 6. 31.
D C A D
A. Applicant’s personal information 7. 32. D 7. 7. D 7. 32.
A B
B. Experience verification: 8. 33. B 8. 8. D 8. 33.
D D
1. Number of jumps
9. C 34. B 9. A 9. A 9. 34.
2. Freefall time

C. Skill verification: Verify (with your initials) that the jump number, date, 10 C 35. D 10 A 10 D 10 35.
or score for each requirement is correct and can be found in the
applicant’s logbook, OR enter the applicant’s appropriate license number 11. A 36. B 11. B 11. A 11. 36.
in the box provided.
12. D 37. C 12. B 12. B 12. 37.
D. Knowledge verification: Check that the written exam answer sheet is
complete with a passing score recorded on the application. 13. C 38. C 13. B 13. D 13. 38.

E. Final Verification: 14. C 39. C 14. D 14. C 14. 39.

1. Sign the verifying official’s certification statement and print your
15. B 40. A 15. C 15. C 15. 40.
name, license number (or title), and date.
2. Mail the completed license application along with the fee. 16. B 16. C 16. B 16.

LICENSE EXAM INSTRUCTIONS 17. B 17. B 17. C 17.

A. Exam administrator: 18. C 18. B 18. B 18.

1. Give the applicant this answer sheet and the questions to the exam.
Do not permit references or other assistance during the exam. After 19. B 19. A 19. B 19.
the test, collect the materials and grade the exam. 75% (19 or more
for the B-license and C-license exam; 30 or more required for the 20. A 20. D 20. C 20.
A-license and D-license exam) is required to pass.
21. B 21. D 21. A 21.
2. Record the score on the license application and in the applicant’s
logbook. The applicant not passing will be eligible to retake this 22. C 22. D 22. D 22.
exam after seven days. To qualify for a higher license, the applicant
must have passed all lower class license exams. 23. B 23. D 23. B 23.

B. Applicant: 24. B 24. A 24. A 24.

1. Write your name on this answer sheet.
25. C 25. B 25. D 25.
2. Select the best available answer for each question and write the
corresponding letter in the space provided. Score: Score: Score: Score:
3. When you finish, return this answer sheet and all exam questions to
the person administering the test to you.

NOTE: USPA license exams must be administered by a USPA Instructor,

Instructor Examiner, Safety & Training Advisor, or a member of the USPA Board.