Att.J-10_Appendix D - End of Course Eval.pdf

Attachment Att.J-10 – Certificate of Training PAGE 1 of 3

CERTIFICATE OF TRAINING - APPENDIX D

This Certificate of Training for engineers, technicians, environmental specialists, and programmers must be prepared by the contractor and furnished to the FAA as evidence of completion of training for the student indicated.

RETURN OF AN ACCURATELY COMPLETED CERTIFICATE OF TRAINING IS ESSENTIAL SINCE CERTIFICATION FOR PAYMENT UNDER THE CONTRACT CANNOT BE MADE UNTIL THIS CERTIFICATE IS RECEIVED.

- * CERTIFICATE MUST BE SIGNED BY THE STUDENT CERTIFYING RECEIPT OF THE COMPLETE COURSE * -

As soon as the training has been completed, the contractor must return this certificate together with the other items specified in the Payment Clause via email to the following:

FAA Mike Monroney Aeronautical Center FAA Academy - ATTN: Contracts, AAQ-740 and Program Administration Branch, AMA-405 robert.graham@faa.gov and

CONTRACTOR:____________________________________

COURSE NAME:____________________________________

COURSE NO.:____________________________________

CONTRACT NO.: 6973GH-_____-D-_____________

DELIVERY ORDER NO.: 6973GH-______-F-_________

STUDENT NAME

FIRST _____________________________ LAST __________________________________

TRAINING DATE(S):

START DATE: _______________________________

END DATE: _______________________________

TOTAL TRAINING HOURS

________________Hours

COMPLETION STATUS: PASS UNSUCCESSFUL WITHDRAWN INCOMPLETE

DATE

I certify that I received the required training as reported herein.

STUDENT SIGNATURE

I certify that I received the required training as reported herein.

CONTRACTOR OFFICIAL SIGNATURE DATE

****NOTE: FAA Student: Your signature certifies that you received the training as indicated in the course description. Payment will be made from this document. Please complete the course evaluation / course information data on pages 2 and 3.

****NOTE: ANY TRAINING TIME (PER INDIVIDUAL) ABOVE AND BEYOND THAT SPECIFIED BY THE ABOVE REFERENCED CONTRACT / ORDER NUMBER REQUIRES ADVANCE APPROVAL FROM THE CONTRACTING

OFFICER.

Revision 4 [2/01/24]

FAAACADEMY

End-of-Course Evaluation

Course:

j I I I I I Training Org: 400

Not like this: "32(

Class: I I I I I I Do not write outside boxes.

The FAA Acalemy wants your candid opinions. Your feedback will help us provide the best possible products and services.

Please rate the course on the following factors:

Highly Somewhat Slightly NotAtAll Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory N/A

Length of course .................... o .................. o ................. o ................. o ................. 0 ................... o

Depth of information ............... o .................. o ................. o ................. o ................. o .................. O

Pace of training ...................... o .................. o ................. o ................. o ................. 0 .................. o

Clarity of objectives ................. o .................. o ................. o ................. O ................. o ................. O •

Relevance to your job .............. o .................. o ................. o ................. o ................. o ................. o

Sequence of content. ............... o .................. o ................. o ................. o ................. 0 ................. o

Opportunity to practice ............ o .................. o ................. o ................. o ................. o ................. o

Suitability of course materials...o .................. o ................. o ................. o ................. 0 ................. O

Effectiveness of instructors..... o .................. o ................. o ................. o ................. o ................. O

Equipment. ............................ o .................. O .................. O ................... O ................. 0.................. O Facilities ................................ o ................. o .................. o .................. o ................. 0................. o

OVERALL QUALITY ...................... o .................. 0 .................. 0 .................. 0 ................ O ................. O

If any area needs improvement, what specific change(s) would you suggest?

Rate how well the training met your needs: 0 Good 0 Average 0 Fair 0 Poor 0 N/A

If you selected "Fair" or "Poor," please explain.

AC Form 3000-143 (11/95) (NSN 0052-00-916-2000)

PLEASE CONTINUE ON THE NEXT PAGE OR OTHER SIDE! ■

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0 Excellent

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