Attachment 03_Appendix A.pdf

CERTIFICATE OF TRAINING - APPENDIX A

This Certificate of Training for pilots and flight engineers shall 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 HAVE THE SIGNATURE OF THE STUDENT CERTIFYING RECEIPT OF THE COURSE FLIGHT, FLIGHT TRAINING DEVICE, SIMULATOR, AND GROUND SCHOOL HOURS COMPLETED- - -

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

FAA Mike Monroney Aeronautical Center FAA Academy - ATTN: Contracts and Program Administration Branch, AMA-260

P.O. Box 25082 Oklahoma City, Oklahoma 73125

CONTRACTOR:_______________________________ CONTRACT NO.: DTFAAC or 6973GH -

COURSE:____________________________________ DELIVERY ORDER NO.: 6973GH-________________________

TYPE OF FLIGHT CHECK COMPLETED (circle)

Initial Qualification Recurrent Qualification Other (specify)_____________________________

TRAINING DATES: TOTAL TRAINING HOURS

GROUND SCHOOL_______________________________ ________________________________Hours

PIC RT SEAT / OBS / F.E.

FLIGHT TRAINING DEVICE_____________________ _________ | ________________Hours

SIMULATOR____________________________________ _________ | ________________Hours

FLIGHT_________________________________________ _________ | ________________Hours

COMPLETION STATUS (circle one): PASS FAIL WITHDRAW INCOMPLETE

I certify that I received the ground school, flight-training device, simulator, and flight time as reported herein.

STUDENT SIGNATURE DATE

CONTRACTOR OFFICIAL SIGNATURE DATE

****NOTE: FAA Student: Your signature certifies that you received the flight, ground school, and simulator time as indicated. 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 [2/11/05]