Checkride Request
Please complete this form in order for your checkride to be scheduled with a DPE. This does NOT reserve an aircraft for your checkride. Please complete a Checkride Plane Request form once your checkride date has been confirmed with the DPE.
Applicant Full Name
*
First Name
Last Name
Applicant Email
*
example@example.com
Applicant Phone Number
*
Please enter a valid phone number.
Requested Date for Checkride
*
-
Month
-
Day
Year
Date
Grade of Certificate Held
*
Class of Certificate Held
*
Applicant FTN Number
*
Applicant Certificate Number
*
Grade of Certificate Sought
*
Part 61 or 141?
*
Aircraft Class Sought
*
Tail # Checkride Aircraft
*
Make/Model Checkride Aircraft
*
Recommending Instructor
*
First Name
Last Name
Recommending Instructor Certificate
*
Certificate Number
Expiration Date
Recommending Instructor Email
*
Recommending Instructor Phone
*
Please enter a valid phone number.
Knowledge Test Number
*
If no knowledge test is required, write N/A.
Knowledge Test Grade
*
If no knowledge test is required, write N/A.
Knowledge Test Date
-
Month
-
Day
Year
Date
Designated Pilot Examiner
We will reach out to the DPE(s) of your choice and try to find an available date.
Choose your DPE(s)
BTV - John Curran (PP, INS, COM, MEL)
BTV - Noah Ranallo (PP, INS, COM)
PBG - Duane Tedesco (PP, INS, COM)
RME - Bill Ziesentiz (COM, MEL, CFI, CFII, MEI)
BTV/EEN - Greg Livernois (PP, INS, COM, CFI, CFII)
ITH - Wayne Kerr (PP)
BTV/BXM - Randall Williams (PP, INS, COM, CFII, MEI)
Any Comments?
Submit
Should be Empty: