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FAA Endorsement Labels

The following endorsements have been compiled from a combination of sources, including the
ASA Logbooks, FAA Advisory Circular (AC) 61-65, and the regulations (14 CFR).
Blank lines indicate where the instructor must fill in details. The parenthetical statement ahead of
each of the blank lines explains what must be defined in this space.
This file has been set up as a “PDF fill-in” document. Instructors may complete the endorsements
using a PDF reader by typing in the blanks. Alternately, the endorsement may be printed out, and
then written in with pen.
Endorsements may be printed on Avery Labels #5163 (or compatible 2"x4" labels) and pasted
into the recipient’s logbook, as well as into the endorsing instructor’s logbook for record-keeping
purposes. Print only the page(s) you need by selecting specific page numbers during Print Setup.

Note: If you are viewing this within the ASA Reader app, the fill-in and print features are not
available. Visit www.asa2fly.com/endorsements to download the PDF to your computer.

Contents:
Pg 2 Flight Review Endorsements
Pg 3 Instrument Proficiency Checks
Pg 4–5 Student Pilot Endorsements
Pg 5–6 Sport Pilot Endorsements
Pg 7 Recreational Pilot Endorsements
Pg 8 Private Pilot Endorsements
Pg 9 Commercial Pilot Endorsements
Pg 10 Instrument Rating Endorsements
Pg 11 Flight Instructor Endorsements
Pg 12 Additional Endorsements

ENDORSE-0319
FLIGHT REVIEW ENDORSEMENT FLIGHT REVIEW ENDORSEMENT
I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

(pilot certificate) , (certificate number) , (pilot certificate) , (certificate number) ,

has satisfactorily completed the flight review required in §61.56(a) on (date) has satisfactorily completed the flight review required in §61.56(a) on (date)

. .

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

FLIGHT REVIEW ENDORSEMENT FLIGHT REVIEW ENDORSEMENT

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

(pilot certificate) , (certificate number) , (pilot certificate) , (certificate number) ,

has satisfactorily completed the flight review required in §61.56(a) on (date) has satisfactorily completed the flight review required in §61.56(a) on (date)

. .

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

FLIGHT REVIEW ENDORSEMENT FLIGHT REVIEW ENDORSEMENT

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

(pilot certificate) , (certificate number) , (pilot certificate) , (certificate number) ,

has satisfactorily completed the flight review required in §61.56(a) on (date) has satisfactorily completed the flight review required in §61.56(a) on (date)

. .

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

FLIGHT REVIEW ENDORSEMENT FLIGHT REVIEW ENDORSEMENT

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

(pilot certificate) , (certificate number) , (pilot certificate) , (certificate number) ,

has satisfactorily completed the flight review required in §61.56(a) on (date) has satisfactorily completed the flight review required in §61.56(a) on (date)

. .

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

FLIGHT REVIEW ENDORSEMENT FLIGHT REVIEW ENDORSEMENT

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

(pilot certificate) , (certificate number) , (pilot certificate) , (certificate number) ,

has satisfactorily completed the flight review required in §61.56(a) on (date) has satisfactorily completed the flight review required in §61.56(a) on (date)

. .

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

INSTRUMENT PROFICIENCY CHECK (IPC) INSTRUMENT PROFICIENCY CHECK (IPC)
I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

(pilot certificate) , (certificate number) , (pilot certificate) , (certificate number) ,

has satisfactorily completed the instrument proficiency check required in has satisfactorily completed the instrument proficiency check required in

§61.57(d) in a (make and model of aircraft) §61.57(d) in a (make and model of aircraft)

on (date) . on (date) .

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

INSTRUMENT PROFICIENCY CHECK (IPC) INSTRUMENT PROFICIENCY CHECK (IPC)

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

(pilot certificate) , (certificate number) , (pilot certificate) , (certificate number) ,

has satisfactorily completed the instrument proficiency check required in has satisfactorily completed the instrument proficiency check required in

§61.57(d) in a (make and model of aircraft) §61.57(d) in a (make and model of aircraft)

on (date) . on (date) .

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

INSTRUMENT PROFICIENCY CHECK (IPC) INSTRUMENT PROFICIENCY CHECK (IPC)

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

(pilot certificate) , (certificate number) , (pilot certificate) , (certificate number) ,

has satisfactorily completed the instrument proficiency check required in has satisfactorily completed the instrument proficiency check required in

§61.57(d) in a (make and model of aircraft) §61.57(d) in a (make and model of aircraft)

on (date) . on (date) .

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

INSTRUMENT PROFICIENCY CHECK (IPC) INSTRUMENT PROFICIENCY CHECK (IPC)

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

(pilot certificate) , (certificate number) , (pilot certificate) , (certificate number) ,

has satisfactorily completed the instrument proficiency check required in has satisfactorily completed the instrument proficiency check required in

§61.57(d) in a (make and model of aircraft) §61.57(d) in a (make and model of aircraft)

on (date) . on (date) .

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

INSTRUMENT PROFICIENCY CHECK (IPC) INSTRUMENT PROFICIENCY CHECK (IPC)

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

(pilot certificate) , (certificate number) , (pilot certificate) , (certificate number) ,

has satisfactorily completed the instrument proficiency check required in has satisfactorily completed the instrument proficiency check required in

§61.57(d) in a (make and model of aircraft) §61.57(d) in a (make and model of aircraft)

on (date) . on (date) .

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

INITIAL SOLO ENDORSEMENT INITIAL SOLO ENDORSEMENT
I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,
has satisfactorily completed the presolo knowledge exam of §61.87(b), received the has satisfactorily completed the presolo knowledge exam of §61.87(b), received the
presolo training required by §61.87 in a (make and model) presolo training required by §61.87 in a (make and model)
, ,
and has demonstrated satisfactory proficiency and safety on the maneuvers and and has demonstrated satisfactory proficiency and safety on the maneuvers and
procedures required by §61.87 in this or similar make and model of aircraft to be flown. procedures required by §61.87 in this or similar make and model of aircraft to be flown.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

NIGHT SOLO ENDORSEMENT NIGHT SOLO ENDORSEMENT

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,
has received the required presolo training of §61.87(o) at (airport) has received the required presolo training of §61.87(o) at (airport)
and determined he/she has demonstrated the proficiency of and determined he/she has demonstrated the proficiency of
§61.87(o) and is proficient to make solo flights at night in a (make and model §61.87(o) and is proficient to make solo flights at night in a (make and model
aircraft) at (airport) until aircraft) at (airport) until
(maximum 90 days from date of training) . (maximum 90 days from date of training) .

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

SOLO FLIGHT FIRST 90-DAY ENDORSEMENT SOLO FLIGHT FIRST 90-DAY ENDORSEMENT
I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,
has received the required training to qualify for solo flying. I have determined he/ has received the required training to qualify for solo flying. I have determined he/
she meets the applicable requirements of §61.87(n) and is proficient to make solo she meets the applicable requirements of §61.87(n) and is proficient to make solo
flights in (make and model aircraft) flights in (make and model aircraft)
until (maximum 90 days from date given) . until (maximum 90 days from date given) .
Limitations:
. Limitations:
.
SIGNED DATE SIGNED DATE
CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

SOLO FLIGHT ADDITIONAL 90-DAY ENDORSEMENT SOLO FLIGHT ADDITIONAL 90-DAY ENDORSEMENT
I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,
has received the required training to qualify for solo flying. I have determined he/ has received the required training to qualify for solo flying. I have determined he/
she meets the applicable requirements of §61.87(p) and is proficient to make solo she meets the applicable requirements of §61.87(p) and is proficient to make solo
flights in (make and model aircraft) flights in (make and model aircraft)
until (maximum 90 days from date given) . until (maximum 90 days from date given) .
Limitations:
. Limitations:
.
SIGNED DATE SIGNED DATE
CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

ADDITIONAL AIRPORT WITHIN 25NM SOLO ENDORSEMENT ADDITIONAL AIRPORT WITHIN 25NM SOLO ENDORSEMENT
I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has received the required training of §61.93(b)(1). I have determined that he/she has received the required training of §61.93(b)(1). I have determined that he/she

is proficient to practice solo takeoffs and landings at (airport name) is proficient to practice solo takeoffs and landings at (airport name)

subject to the following conditions: subject to the following conditions:

. .

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

INITIAL CROSS-COUNTRY SOLO ENDORSEMENT INITIAL CROSS-COUNTRY SOLO ENDORSEMENT
I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has received the required solo cross-country training. I find he/she has met the has received the required solo cross-country training. I find he/she has met the

applicable requirements of §61.93, and is proficient to make solo cross-country applicable requirements of §61.93, and is proficient to make solo cross-country

flights in a (make and model aircraft) , flights in a (make and model aircraft) ,

(aircraft category) . (aircraft category) .

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

CROSS-COUNTRY SOLO ENDORSEMENT (EACH FLIGHT) CROSS-COUNTRY SOLO ENDORSEMENT (EACH FLIGHT)
I have reviewed the cross-country planning of (First name, MI, Last name) I have reviewed the cross-country planning of (First name, MI, Last name)
and find the planning and preparation and find the planning and preparation
to be correct to make the solo flight from (location) to be correct to make the solo flight from (location)
to (destination) via (route of flight) to (destination) via (route of flight)
with landings at (name the airports) with landings at (name the airports)
in a (make and model aircraft) on (date) . in a (make and model aircraft) on (date) .
Limitations:
. Limitations:
.
SIGNED DATE SIGNED DATE
CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

REPEAT X/C SOLO ENDORSEMENT (LESS THAN 50 NM) REPEAT X/C SOLO ENDORSEMENT (LESS THAN 50 NM)
I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,
has received the required training in both directions between and at both (airport has received the required training in both directions between and at both (airport
names) and determined that he/she names) and determined that he/she
is proficient in §61.93(b)(2) to conduct repeated solo cross-country flights over is proficient in §61.93(b)(2) to conduct repeated solo cross-country flights over
that route, which is not more than 50NM from the point of departure, subject to that route, which is not more than 50NM from the point of departure, subject to
the following conditions: . the following conditions: .
SIGNED DATE SIGNED DATE
CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

CLASS B SOLO ENDORSEMENT CLASS B SOLO ENDORSEMENT

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has received the required training of §61.95(a). I have determined he/she is has received the required training of §61.95(a). I have determined he/she is

proficient to conduct solo flights in (name of Class B) proficient to conduct solo flights in (name of Class B)

airspace. To include flight operations at (list any applicable airport) . airspace. To include flight operations at (list any applicable airport) .

Limitations: . Limitations: .

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

SPORT PILOT SOLO FLIGHT IN CLASS B, C, AND D AIRSPACE SPORT PILOT SOLO FLIGHT IN CLASS B, C, AND D AIRSPACE
(required each additional 90-day period) (required each additional 90-day period)
I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,
has received the required training of §61.94(a). I have determined he/she is has received the required training of §61.94(a). I have determined he/she is
proficient to conduct solo flights in (name of Class B, C, or D) airspace and proficient to conduct solo flights in (name of Class B, C, or D) airspace and
authorized to operate to, from, through, and at
airport. authorized to operate to, from, through, and at
airport.
Limitations:
. Limitations:
.
SIGNED DATE SIGNED DATE
CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE
SPORT PILOT KNOWLEDGE TEST SPORT PILOT—TAKING FLIGHT PROFICIENCY CHECK FOR
AN ADDITIONAL AIRCRAFT
I certify that (First name, MI, Last name) ,
I certify that (First name, MI, Last name) ,
has received the required aeronautical knowledge training of §61.309. I have
has received the required training of §§61.309 and 61.311. I have determined that
determined that he/she is prepared for the (name the knowledge test / aircraft
he/she is prepared for the (category / class)
category) / .
proficiency check.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

REVIEW OF AIRMAN KNOWLEDGE TEST SPORT PILOT— PASSING FLIGHT PROFICIENCY CHECK FOR
AN ADDITIONAL AIRCRAFT
I certify that (First name, MI, Last name) ,
I certify that (First name, MI, Last name) ,
has demonstrated satisfactory knowledge of the subject areas in which he/she
has met the training and endorsement requirements of §§61.309 and 61.311.
was deficient on the (test name)
I have determined him/her proficient to act as PIC of (category / class)
airman knowledge test.
of light-sport aircraft.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

PREREQUISITES FOR PRACTICAL TEST AIRSPACE ENDORSEMENT CLASS B, C, AND D

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has received and logged training time within 2 calendar months preceding the has received the required training of §61.325. I have determined he/she is pro-

month of application in preparation for the practical test for the issuance of Sport ficient to conduct operations in Class B, C, or D airspace, at an airport located

Pilot Certificate. in Class B, C, or D airspace, or to, from, through, or on an airport having an

operational control tower.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

TAKING THE SPORT PILOT PRACTICAL TEST LIGHT-SPORT AIRCRAFT, VH ≤ 87 KCAS

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has received the required training of §§61.309 and 61.311 and met the experience has received the required training in accordance with §61.327(a) in a (make and

requirements of §61.313. I have determined that he/she is prepared for the model aircraft) . I have determined him/her

(category / class) practical test. proficient to act as PIC of a light-sport aircraft that has a VH less than or equal to

87 KCAS.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

PASSING THE SPORT PILOT PRACTICAL TEST LIGHT-SPORT AIRCRAFT, VH > 87 KCAS
I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has met the training and endorsement requirements of §§61.309, 61.311 and has received the required training in accordance with §61.327(b) in a (make and

61.313. I have determined him/her proficient to act as PIC of (category / class) model aircraft) . I have determined him/her

of light-sport aircraft. proficient to act as PIC of a light-sport aircraft that has a VH greater than 87 KCAS.

SIGNED DATE SIGNED DATE

PILOT CERT # SPE # EXP. DATE CFI NO. EXPIRATION DATE

RECREATIONAL PILOT KNOWLEDGE TEST RECREATIONAL PILOT—PIC FLIGHTS GREATER THAN 50 NM
I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has received the required training of §61.97(b). I have determined that has received the required cross-country training of §61.101(c). I have determined

he/she is prepared for the (name of test) / he/she is proficient in cross-country flying of part 61 subpart E.

knowlege test.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

REVIEW OF AIRMAN KNOWLEDGE TEST RECREATIONAL PILOT—180 DAY RECURRENT TRAINING

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has demonstrated satisfactory knowledge of the subject areas in which he/she has received the required 180-day recurrent training of §61.101(g) in a (make and

was deficient on the (test name) model aircraft) . I have determined

airman knowledge test. him/her proficient to act as PIC of that aircraft.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

PREREQUISITES FOR PRACTICAL TEST RECREATIONAL PILOT—180 DAY RECURRENT TRAINING

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has received and logged training time within 2 calendar months preceding the has received the required 180-day recurrent training of §61.101(g) in a (make and

month of application in preparation for the practical test and he/she is prepared model aircraft) . I have determined

for the required practical test for the issuance of Recreational Pilot Certificate. him/her proficient to act as PIC of that aircraft.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

RECREATIONAL PILOT PRACTICAL TEST SOLO FLIGHT FOR ADDED CERTIFICATE OR RATING
I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has received the required training of §§61.98(b) and 61.99. I have determined has received the required training of §61.87 in a (make and model aircraft)

that he/she is prepared for the (name of test) . I have determined he/she

practical test. is prepared to conduct a solo flight on (date) under the following

conditions: .

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

RECREATIONAL PILOT— PIC WITHIN 50 NM OF AIRPORT RECREATIONAL PILOT—AIRSPACE ENDORSEMENT

CLASS B, C, AND D
I certify that (First name, MI, Last name) ,
I certify that (First name, MI, Last name) ,
has received the required training of §61.101(b). I have determined he/she is
has received the required training of §61.101(d). I have determined he/she is
competent to operate at the (name of airport) .
proficient to conduct operations in Class B, C, or D airspace, at an airport lo-
cated in Class B, C, or D airspace, or to, from, through, or on an airport having
an operational control tower.
SIGNED DATE SIGNED DATE
CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE
PRIVATE PILOT KNOWLEDGE TEST PRIVATE PILOT PRACTICAL TEST
I certify that (First name, MI, Last name) Sean
Walsh , I certify that (First name, MI, Last name) ,

has received the required training in accordance with §61.105. I have determined has received the required training in accordance with §§61.107 and 61.109. I have

he/she is prepared for the (name of test) determined he/she is prepared for the (name of test)

knowledge test. practical test.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

PRIVATE PILOT KNOWLEDGE TEST REVIEW OF AIRMAN KNOWLEDGE TEST

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has received the required training in accordance with §61.105. I have determined has demonstrated satisfactory knowledge of the subject areas in which he/she

he/she is prepared for the (name of test) was deficient on the (test name)

knowledge test. airman knowledge test.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

PRIVATE PILOT KNOWLEDGE TEST REVIEW OF AIRMAN KNOWLEDGE TEST

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has received the required training in accordance with §61.105. I have determined has demonstrated satisfactory knowledge of the subject areas in which he/she

he/she is prepared for the (name of test) was deficient on the (test name)

knowledge test. airman knowledge test.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

PRIVATE PILOT PRACTICAL TEST PREREQUISITES FOR PRACTICAL TEST

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has received the required training in accordance with §§61.107 and 61.109. I have has received and logged training time within 2 calendar months preceding the

determined he/she is prepared for the (name of test) month of application in preparation for the practical test and he/she is prepared

practical test. for the required practical test for the issuance of Private Pilot Certificate.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

PRIVATE PILOT PRACTICAL TEST PREREQUISITES FOR PRACTICAL TEST

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has received the required training in accordance with §§61.107 and 61.109. I have has received and logged training time within 2 calendar months preceding the

determined he/she is prepared for the (name of test) month of application in preparation for the practical test and he/she is prepared

practical test. for the required practical test for the issuance of Private Pilot Certificate.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

COMMERCIAL PILOT KNOWLEDGE TEST COMMERCIAL PILOT PRACTICAL TEST
I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has received the required training in accordance with §61.125. I have determined has received the required training of §§61.127 and 61.129. I have determined

he/she is prepared for the (name of test) he/she is prepared for the (name of test)

knowledge test. practical test.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

COMMERCIAL PILOT KNOWLEDGE TEST REVIEW OF AIRMAN KNOWLEDGE TEST

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has received the required training in accordance with §61.125. I have determined has demonstrated satisfactory knowledge of the subject areas in which he/she

he/she is prepared for the (name of test) was deficient on the (test name)

knowledge test. airman knowledge test.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

COMMERCIAL PILOT KNOWLEDGE TEST REVIEW OF AIRMAN KNOWLEDGE TEST

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has received the required training in accordance with §61.125. I have determined has demonstrated satisfactory knowledge of the subject areas in which he/she

he/she is prepared for the (name of test) was deficient on the (test name)

knowledge test. airman knowledge test.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

COMMERCIAL PILOT PRACTICAL TEST PREREQUISITES FOR PRACTICAL TEST

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has received the required training of §§61.127 and 61.129. I have determined has received and logged training time within 2 calendar months preceding the

he/she is prepared for the (name of test) month of application in preparation for the practical test and he/she is prepared

practical test. for the required practical test for the issuance of Commercial Pilot Certificate.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

COMMERCIAL PILOT PRACTICAL TEST PREREQUISITES FOR PRACTICAL TEST

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has received the required training of §§61.127 and 61.129. I have determined has received and logged training time within 2 calendar months preceding the

he/she is prepared for the (name of test) month of application in preparation for the practical test and he/she is prepared

practical test. for the required practical test for the issuance of Commercial Pilot Certificate.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

INSTRUMENT KNOWLEDGE TEST INSTRUMENT PRACTICAL TEST
I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has received the required training of §61.65(b). I have determined that he/she is has received the required training of §61.65(c) and 61.65(d). I have determined

prepared for the instrument–(airplane, helicopter, or powered-lift) that he/she is prepared for the instrument–(airplane, helicopter, or powered-lift)

knowledge test. practical test.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

INSTRUMENT KNOWLEDGE TEST INSTRUMENT PRACTICAL TEST

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has received the required training of §61.65(b). I have determined that he/she is has received the required training of §61.65(c) and 61.65(d). I have determined

prepared for the instrument–(airplane, helicopter, or powered-lift) that he/she is prepared for the instrument–(airplane, helicopter, or powered-lift)

knowledge test. practical test.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

INSTRUMENT KNOWLEDGE TEST PREREQUISITES FOR PRACTICAL TEST

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,
has received and logged the required flight time/training of § 61.39(a) in preparation
has received the required training of §61.65(b). I have determined that he/she is
for the practical test within 2 calendar-months preceding the date of the test and
prepared for the instrument–(airplane, helicopter, or powered-lift)
has satisfactory knowledge of the subject areas in which he/she was shown to
knowledge test.
be deficient by the FAA airman knowledge test report. I have determined he/she
is prepared for the Instrument–[airplane, helicopter, or powered-lift] practical test.
SIGNED DATE SIGNED DATE
CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

INSTRUMENT KNOWLEDGE TEST PREREQUISITES FOR PRACTICAL TEST

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,
has received and logged the required flight time/training of § 61.39(a) in preparation
has received the required training of §61.65(b). I have determined that he/she is
for the practical test within 2 calendar-months preceding the date of the test and
prepared for the instrument–(airplane, helicopter, or powered-lift)
has satisfactory knowledge of the subject areas in which he/she was shown to
knowledge test.
be deficient by the FAA airman knowledge test report. I have determined he/she
is prepared for the Instrument–[airplane, helicopter, or powered-lift] practical test.
SIGNED DATE SIGNED DATE
CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

INSTRUMENT PRACTICAL TEST PREREQUISITES FOR PRACTICAL TEST

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,
has received and logged the required flight time/training of § 61.39(a) in preparation
has received the required training of §61.65(c) and 61.65(d). I have determined
for the practical test within 2 calendar-months preceding the date of the test and
that he/she is prepared for the instrument–(airplane, helicopter, or powered-lift)
has satisfactory knowledge of the subject areas in which he/she was shown to
practical test.
be deficient by the FAA airman knowledge test report. I have determined he/she
is prepared for the Instrument–[airplane, helicopter, or powered-lift] practical test.
SIGNED DATE SIGNED DATE
CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE
SPIN TRAINING SPIN TRAINING
I certify that (First name, MI, Last name) I certify that (First name, MI, Last name)

has received the required training of §61.183(i). I have determined that he/she has received the required training of §61.183(i). I have determined that he/she

is competent in instructional skills for training stall awareness, spin entry, spins, is competent in instructional skills for training stall awareness, spin entry, spins,

and spin recovery procedures. and spin recovery procedures.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

FLIGHT INSTRUCTOR PRACTICAL TEST FLIGHT INSTRUCTOR PRACTICAL TEST

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has received the required training of §61.187(b). I have determined he/she is has received the required training of §61.187(b). I have determined he/she is

prepared for the CFI—(aircraft category and class) prepared for the CFI—(aircraft category and class)

practical test. practical test.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

FLIGHT INSTRUCTOR PRACTICAL INSTRUMENT FLIGHT INSTRUCTOR PRACTICAL INSTRUMENT

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has received the required CFII training of §61.187(b)(7). I have determined he/ has received the required CFII training of §61.187(b)(7). I have determined he/

she is prepared for the CFII—(airplane, helicopter, or powered-lift) she is prepared for the CFII—(airplane, helicopter, or powered-lift)

practical test. practical test.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

REVIEW OF AIRMAN KNOWLEDGE TEST REVIEW OF AIRMAN KNOWLEDGE TEST

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has demonstrated satisfactory knowledge of the subject areas in which he/she has demonstrated satisfactory knowledge of the subject areas in which he/she

was deficient on the (test name) was deficient on the (test name)

airman knowledge test. airman knowledge test.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

PREREQUISITES FOR PRACTICAL TEST PREREQUISITES FOR PRACTICAL TEST

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has received and logged training time within 2 calendar months preceding the has received and logged training time within 2 calendar months preceding the

month of application in preparation for the practical test and he/she is prepared month of application in preparation for the practical test and he/she is prepared

for the required practical test for the issuance of Flight Instructor Certificate. for the required practical test for the issuance of Flight Instructor Certificate.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

COMPLEX AIRPLANE COMPLEX AIRPLANE
I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

(pilot certificate) , (certificate number) , (pilot certificate) , (certificate number) ,

has received the required training of §61.31(e) in a (make and model of complex has received the required training of §61.31(e) in a (make and model of complex

airplane) . I have determined airplane) . I have determined

that he/she is proficient in the operation and systems of a complex airplane. that he/she is proficient in the operation and systems of a complex airplane.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

HIGH-PERFORMANCE AIRPLANE HIGH-PERFORMANCE AIRPLANE

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,
(pilot certificate) , (certificate number) , (pilot certificate) , (certificate number) ,
has received the required training of §61.31(f) in a (make and model of high has received the required training of §61.31(f) in a (make and model of high
performance airplane) . performance airplane) .
I have determined that he/she is proficient in the operation and systems of a high I have determined that he/she is proficient in the operation and systems of a high
performance airplane. performance airplane.
SIGNED DATE SIGNED DATE
CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

TAILWHEEL TAILWHEEL
I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

(pilot certificate) , (certificate number) , (pilot certificate) , (certificate number) ,

has received the required training of §61.31(i) in a (make and model of tailwheel has received the required training of §61.31(i) in a (make and model of tailwheel

airplane) . I have determined airplane) . I have determined

that he/she is proficient in the operation of a tailwheel airplane. that he/she is proficient in the operation of a tailwheel airplane.

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

HIGH ALTITUDE HIGH ALTITUDE

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,
(pilot certificate) , (certificate number) , (pilot certificate) , (certificate number) ,
has received the required training of §61.31(g) in a (make and model of pressur- has received the required training of §61.31(g) in a (make and model of pressur-
ized aircraft) . ized aircraft) .
I have determined that he/she is proficient in the operation and systems of a I have determined that he/she is proficient in the operation and systems of a
pressurized aircraft. pressurized aircraft.
SIGNED DATE SIGNED DATE
CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE

TSA CITIZENSHIP VERIFICATION TSA CITIZENSHIP VERIFICATION

I certify that (First name, MI, Last name) , I certify that (First name, MI, Last name) ,

has presented me a (type of identification) has presented me a (type of identification)

establishing that he/she is a U.S. citizen or establishing that he/she is a U.S. citizen or

national in accordance with 49 CFR §1552.3(h). national in accordance with 49 CFR §1552.3(h).

SIGNED DATE SIGNED DATE

CFI NO. EXPIRATION DATE CFI NO. EXPIRATION DATE