ATTACHMENT 3 Appendix A (2) Cert - Eval (1).pdf

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Attachment 2

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 A CCU RA TELY COMPLETED CERTIFICATE OF TRAINING IS ESSENTIAL SINCE

CERTIFICATION FOR PAYMENT UNDER THE CONTRACT CANNOT BE MADE UNTIL THIS CERTIFICATE IS RECEIVED - - - CERTIFICATE MUST HA VE 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 certificnte 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, Ok!Ahoma 73125

CONTRACTOR: __ ________ _

COURSE: ____________ _

CONTRACT NO.: DTFA-AC-_________ _

DELIVERY ORDER NO.: ________ _

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 12/11/051

II� FAA ACADEMY

End-or-Course Evaluation

II

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Course: J I I j I I Class: r-·-,-r I I I Training Org: l2160j Shade circles like this: • Not like this: � �

Do not write outside boxes.

The FAA Acoocmy wants your candid opinions. Your feed bock will help us provide the best possible products and services.

Please rate the course on the following factors:

Highly Somewhat Slightly Not At All SatisFactrny 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 ................. o .................. o

Clarity of objectives ................ Q .................. Q ................. o ................. o ................. o ................. o

Aelevance toyourjob ............ o .................. Q ................. o ................. o ................. Q ................. o

Sequence of content. ............ o .................. o ................. o ................. o ................. O······· .......... o

Opportunity to practice .......... o .................. o ................. o ................. o ................. 0 ................. o

Suitability of course materials.a .................. o ................. o ................. o ................. Q................. O Effectiveness of instructors .... o .................. o ................. o ................. o ................. o ................. o

Equipment. .......................... o .................. o .................. Q .................. Q ................. · Q ................. O Facilities............................... o ................. o .................. o .................. o .. ... . . . . . .. .. . .. O·.............. .. o

OVERALL QUALITY ............. O .................. O .................. O .................. Q ... .. .... . ... ... O

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

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

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

II

AC Fom1 3000-143 (11/95) (NSN 0052-00-916-2000)

PLEASE CONTINUE ON THE OTHER SIDE! II

Iffi ,18713

COMMENTS: (Please eategorize any comment by prindng ir in $re appropriare spaco and darkening rhr circle.)

REMINUHR: Did you darken the circle of each comrnent? THANK VOU!