Form 2120-0574 General Aviation Awards Program Application Form

2016 GENERAL AVIATION AWARDS
APPLICATION GENERAL INFORMATION
The General Aviation Awards Program is a cooperative effort between the FAA and industry sponsors to
annually recognize outstanding individuals in avionics, flight instruction, maintenance and those serving as FAASTeam
Representatives. The awards highlight the important roles these individuals play in promoting aviation safety,
education, and professionalism.
Winners are recognized locally, regionally and nationally. 2016
application/nominations are accepted from July 1 thru September 30, 2015. National honorees are announced in early
2016 and recognized during AirVenture, in Oshkosh in July 2016. They also receive gifts provided by sponsors.

ELIGIBILITY
Candidates must have been actively working, within the United States, in their respective field for a minimum
of five years prior to nomination.
Candidates may nominate themselves.
Candidates must hold a current FAA airman certificate (if required). During the preceding five years,
candidates must not have had an airman certificate suspended, revoked, subject to enforcement action; or, have been
convicted of a civil or criminal offense. In addition:
A) Maintenance Technician candidates must be working under FAR Part 65;
B) Avionics Technician candidates must be working with a Part 145 Repair Station;
C) Certificated Flight Instructor candidates must be working under FAR Part 61, 141 or 142;
D) FAASTeam Representative candidates must be actively involved in the FAA Safety Team.

PACKAGE COMPONENTS
Submitted nominations become the property of the General Aviation Awards Program. The application
package must include the required checklist items listed below and only those items. Additional information will be
discarded. Missing or illegible checklist items may lead to disqualification. Please, no cover sheets or excess
bulk…make it complete but concise:
1. Application Page 1 – and, don’t forget to sign it!
2. Application Page 2 (additional pages are allowed)
3. Your aviation c/v. More than just a résumé, but no more than two pages.
4. Clear copy of a current U.S. government-issued photo-id. A driver’s license is but one option but other options
include an airport SIDA Badge, Passport, CCDW Permit, Military ID, and Government Employee ID.
5. Clear copy of both sides of current FAA certificates/designations
6. One letter of recommendation from a supervisor (employer, FPM, Chief CFI or DPE, etc)
7. One letter of recommendation from a peer or co-worker
8. One letter of recommendation from a client who is familiar with your work
a. Letters of recommendation must be no more than one page each
9. A high-resolution JPEG, taken within the past five years, in a professional aviation setting.
10. Supporting documents for each item listed on Application Page 2
The easiest, fastest way to prepare your packet is to gather everything and take it to an office supply or printing
house. They can scan everything into a single pdf document. Judges prefer pages assembled in the sequence listed
above.
Name your document using the 3-letter award-type identifier, Last Name. As an example: CFI, Smith.

SUBMITTING YOUR PACKAGE
All applications are submitted online. Log on to www.generalaviationawards.com and the NOMINATIONS
page to upload it. You’ll find additional instructions there.
Paperwork Reduction Act Statement: A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a
collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this
information collection is 2120-0574. Public reporting for this collection of information is estimated to be approximately 4 hours per response, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All responses to this collection of information are voluntary. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the FAA at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information
Collection Clearance Officer, ASP-110.

Questions? Email: [email protected]
Rev 5/2015

OMB #2120-0574
Exp. 8/31/2015

2016 GENERAL AVIATION AWARDS
APPLICATION - PAGE 1

This nomination is for (choose one)
FSDO Office
City, ST or Number
FAASTeam Mgr’s
Phone

Candidate’s Name

FAASTeam Mgr’s
Name
FAASTeam Mgr’s
Email
First

Middle

Last

Preferred Name

Street Address
City

ST

Zip

Preferred Phone

E-Mail

Year original FAA
cert was issued
Full Time Employer
Company Name

Supervisor’s
Name

Phone:

E-Mail

Street Address
City, ST Zip
Part Time Employer
Company Name

Supervisor’s
Name

Phone:

E-Mail

Street Address
City, ST Zip
Nominator’s
Name

Relationship to
Nominee

Phone

E-Mail

Affidavit
I hereby attest that all information submitted herein is true, correct, and complete. I understand that any misrepresentation of
facts may result in removal from award consideration. I authorize present and past employers, the Federal Aviation Administration, and
law enforcement agencies to disclose to representatives of the General Aviation Awards Program information about me from the records in
their possession, and to provide copies of that information if requested by the General Aviation Awards Program.
Date

Candidate’s
Signature

Questions? Email: [email protected]
Rev 5/2015

GENERAL AVIATION AWARDS
APPLICATION - PAGE 2

Candidate for

Candidate’s Name

We are looking for aviation-citizens; for leaders; for experienced people who can be heralded as role
models. Judges focus on professional activities, continuing education and pro-bono service to the aviation industry.
The highest scores go to those with sustained, superior, performance and specific contributions to aviation safety,
education, and professionalism. Your aviation auto-biography tells your complete history; on this page, judges
will focus on your activities over the last five years.
We’ve given you space for five items in each category, but feel free to include more on additional paper.
Improve your chances of receiving the highest honor by providing support documentation for important projects.
Lastly, please type - as with everything in aviation, professional documentation reflects on you as a professional.

PROFESSIONAL ACTIVITIES

Tell us what you’ve done in the past five years; work, job
responsibilities, aviation activities, etc. Activities should be relevant to the award you are applying for. i.e.:
judges of REP nominees are interested in activities that support the FAASTeam. Use more paper, if needed.

1.
2.
3.
4.
5.

CONTINUING EDUCATION & DEVELOPMENT

The world moves fast in aviation and you can’t be
viewed as a pro if you’re skills/knowledge aren’t top par. Tell us about your recent certificate renewals; about
additional FAA certificates/designations recently earned, college/technical school classes, recurrent or upgrade
training, self-study and industry seminars. We’re interested in only the past five years. You get the idea!

1.
2.
3.
4.
5.

PRO BONO SERVICE TO THE AVIATION COMMUNITY

Every professional gives-back to their
industry. Tell us about your service in the past five years on boards or committees, classes you’ve taught,
mentoring, Scouts, Young Eagles, AOPA Airport Support Network, EAA Technical Counselor, Civil Air Patrol,
articles, blogs or newletters you’ve written, advocacy efforts, responses to Notices for Proposed Rulemaking, etc.

1.
2.
3.
4.
5.

Questions? Email: [email protected]
Rev 5/2015