Form 8710-11 Airman Certificate and/or Rating Application - Sport Pil

U.S. Department
of Transportation
Federal Aviation
Administration

FAA Form 8710-11, Airman Certificate

and/or Rating Application

Supplemental Information and Instructions

Paperwork Reduction Act Statement
The information collected on this form is necessary to determine applicant eligibility for airman ratings. We
estimate it will take 15 minutes to complete this form. The information collected is required to obtain a
benefit and becomes part of the Privacy Act system of records DOT/FAA 847, Aviation Records on
Individuals. Please not that an agency may not conduct or sponsor, and a person is not required to respond
to, a collection of information unless it displays a currently valid OMB control number. The OMB control
number associated with this collection is 2120-0021. Comments concerning the accuracy of this burden and
suggestions for reducing the burden should be directed to the FAA at:800 Independence Ave SW,Washington,
DC 20591, Attn: Information Collection Clearance Officer, ABA-20 .

Privacy Act
The information on the accompanying form is solicited under authority of Title 14 of the code of Federal
Regulations (14 CFR), Part 61. The purpose of this data is to be used to identify and evaluate your
qualifications and eligibility for the issuance of an airman certificate and/or rating. Submission of all
requested data is mandatory, except for the Social Security Number (SSN) which is voluntary. Failure to
provide all the required information would result in you not being issued a certificate and/or rating. The
information would become part of the Privacy Act System of records DOT/FAA 847, Aviation Records on
Individuals. The information collected on this form would be subject to the published routine uses of
DOT.FAA 847. Those routine users are: (a) To provide basic airman certification and qualification
information to the public upon request. (b) To disclose information to the National Transportation Safety
Board (NTSB) in connection with its investigation responsibilities. (c) To provide information about airman
apprehension of drug-law violators. (d) To provide information about enforcement actions arising out of
violations of the Federal Aviation regulations to government agencies, the aviation industry, and the public
upon request. (e) To disclose information to another Federal agency, or to a court or an administrative
tribunal, when the Government or one of its agencies is a party to judicial proceeding before the court or
involved in administrative proceedings before the tribunal.
Submission of your Social Security Number is voluntary. Disclosure of your SSN will facilitate maintenance
of your records which are maintained in alphabetical order and cross references with your SSN and airman
certificate number to provide prompt access. In the event of nondisclosure, a unique number will be
assigned to your file.
If an electronic form is not printed on a duplex printer, the applicant’s name, date of birth, and certificate
number (if applicable) must be furnished on the reverse side of the application. This information is required
for identification purposes. The telephone number and E-mail address are optional

FAA Form 8710-11 (02-04)

Form Approved OMB No: 2120-0690

07/31/2007

U.S. Department of Transportation
Federal Aviation Administration

Airman Certificate and/or Rating Application – Sport Pilot

Student

I. Application Information

Airplane

Sport

Private

Gyroplane

Balloon

Flight Instructor

Proficiency Check
Airship

Additional Rating
Powered Parachute

Renewal

Initial

Reexamination

Glider

Weight Shift Control

Reinstatement

Reissuance of

Other

certificate

A. Name (Last, First, Middle)

B. SSN (US only)

C. Date of Birth

E. Address

F. Citizenship

Specify

City, State, Zip Code

USA
H. Height

M. Do you now hold, or have you ever held an FAA Pilot Certificate?

N. Grade Pilot Certificate

O. Certificate Number

S. Date Issued

T. Name of Examiner

(Citizenship)

Yes
Q. Do you hold a

Yes
No

Medical Certificate?

G. Do you read, speak,
write & understand the
English language?
J. Hair
K. Eyes
L. Sex

Other
I. Weight
In.

D. Place of Birth

lbs.

Yes
No

Male
Female
P. Date Issued

No

R. Class of Certificate

U. Do you hold a US

V. License Number
W. State of Issuance
X. Date Issued
Yes
No
Za. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant
Yes
No
or stimulant drugs or substances.

Y. Expiration Date

Driver’s License?

Zb. Date of Final Conviction

If Certificate, Privilege or Rating Applied For on Basis of:
A. Completion of
Required Test

1. Aircraft to be used (if flight test required)

2a. Total Time in this aircraft SIM/FTD

1)

1)

2)

1. Name and Location of Training Agency or Training Center

1)
2)
hours
1a. Certification Number

2. Curriculum From Which Graduated

3. Date

SIM)

B. Graduate of
Approved/Accepted
Course

1. Country
C. Holder of
Foreign License
Issued By

2b. Pilot in Command

2)
FTD)

hours

2. Grade of License

3. Number

4. Ratings

III. Record of Pilot Time (Do not write in the shaded areas)
Total

Instruction
Received

Solo

Pilot In
Command
(PIC)

Cross
Country
Instruction
Received

Cross
Country
Solo

Cross
Country
PIC

Instrument

Night
Instruction
Received

Night
Takeoff
Landings

Night
PIC

Night
Takeoff
Landing
PIC

PIC

PIC

PIC

PIC

SIC

SIC

SIC

SIC

PIC

PIC

PIC

PIC

SIC

SIC

SIC

SIC

Number
of
Flights

Number
of
AeroTows

Number
of
Ground
Launches

Number of
Powered
Launches

Airplanes
Rotorcraft
(Gyroplane
Only)

Gliders

Lighter
Than Air

Weightshift
Control

Powered
Parachute

IV. Have you failed a test for this certificate, privilege or rating?

Yes

No

V. Applicant’s Certification – I certify that all statements and answers provided by me on this application form are complete and true to the best of my knowledge and I agree that they are to
be considered as part of the basis for issuance of any FAA certificate to me. I have also read and understand the Privacy Act Statement that accompanies this form.

Signature of Applicant
FAA Form 8710-11 (02-04)

Date

Instructor’s Recommendation
I have personally instructed the applicant and consider this person ready to take the test.

Date

Instructor’s Signature (Print name & Sign)

Certificate No.

Certificate Expires

Air Agency’s Recommendation
This applicant has successfully completed our

Course, and is

recommended for certification, privilege or rating without further
Date

test.

Agency Name and Number

Official’s Signature
Title

Designated Examiner or Airman Certification Representative Report
Student Pilot Certificate Issued (Copy Attached)
I have personally reviewed this applicant’s pilot logbook and/or training record, and certify that the individual meets the

pertinent requirements of 14 CFR part 61 for the pilot certificate, privilege or rating sought.

I have personally reviewed this applicant’s graduation certificate, and found it to be appropriate and in order, and have returned the certificate.

I have personally tested and/or verified this applicant in accordance with pertinent procedures and standards with the result indicated below.

Approved – Temporary Certificate Issued (Original Attached)

Disapproved – Disapproval Notice Issued (Original Attached)

Location of Test (Facility, City, State)

Duration of Test
Ground

Certificate or Rating for which tested

Date

Simulator/FTD

Type(s) of Aircraft Used

SIM)
FTD)
Registration No(s)

1)

1)

2)

Examiner’s Signature (Print Name & Sign)

Certificate No.

Flight
1)
2)

2)

Designation No.

Designation Expires

Proficiency Check – Instructor’s Record
I have successfully reviewed this applicants pilot logbook and/or training record and certify the individual meets the pertinent requirements of 14 CFR part 61 (Subparts
K {61.419} or J{61.321} for the proficiency check sought.
I have personally tested this applicant in accordance with the pertinent procedures and standards of 14 CFR pert 61 (Subparts K or J), and find the applicant proficient
in

and

light-sport aircraft.

Proficiency Check:
Instructor’s Signature (Print Name & Sign)

Date

Satisfactory

Unsatisfactory

Certificate No.

Expiration Date:

Aviation Safety Inspector or Technician Report
I have personally tested this applicant in accordance with or have otherwise verified that this applicant complies with pertinent procedures, standards, policies, and or

necessary requirements with the result indicated below.

Approved – Temporary Certificate Issued (Original Attached)

Disapproved – Disapproval Notice Issued (Original Attached)
Satisfactory
Unsatisfactory

Proficiency Check:
Location of Test (Facility, City, State)

Duration of Test
Ground

Certificate or Rating for which tested

Student Pilot Certificate Issued
Examiner’s Recommendation

ACCEPTED

REJECTED

Type(s) of Aircraft Used
1)

1)

2)

Certificate or Rating Based on
Foreign License
Approved Course Graduate
Other Approved FAA Qualification Criteria

Reissue or Exchange of Pilot Certificate
Training Course (FIRC) Name

Date

Student Pilot Certificate (Copy)

Notice of Disapproval
Superseded Airman Certificate
FAA Form 8710-11 (02-04)

ID:

Name:

Form of ID

Knowledge Test Report

Temporary Airman Certificate

Certificate No.

Airman’s Identification (ID)

Date of Birth:
Number
Certificate Number:

Expiration Date

Email Address:

Telephone Number

Flight
1)
2)

2)

Flight Instructor

Renewal
Reinstatement

Instructor Renewal Based on
Activity
Training Course
Test
Duties and Responsibilities

Graduation Certificate No.
Date

Inspector’s Signature (Print Name & Sign)

Attachments:

Simulator/FTD

SIM)
FTD)
Registration No(s)

FAA District Office

U.S. Department of Transportation
Federal Aviation Administration

Airman Certificate and/or Rating Application – Sport Pilot
ADDITIONAL ADDRESS INFORMATION

Name (Last, First, Middle)
Social Security Number
Certificate Number
Date Issued

Permanent Mailing Address:

Address the applicant requests the certificate to be sent:

Street

Street

P.O. Box

P.O. Box

City, State, Zip Code

City, State, Zip Code

Physical Description as entered:

Comments:

FAA Form 8710-11 (02-04)

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