Form 8710-1 Airman Certificate and/or Rating Application Supplementa

FAA Form 8710-1, Airman Certificate
and/or Rating Application
Supplemental Information and
Instructions
OMB CONTROL NUMBER: 2120-0021
EXPIRATION DATE: 08/31/2025

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 2120-0021. Public reporting for this collection of information is
estimated to be approximately 30 minutes 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: Information Collection
Clearance Officer, Federal Aviation Administration, 10101 Hillwood Parkway, Fort Worth, TX 76177-1524

See attached Privacy Act Information and Pilot’s Bill of Rights Written Notification of
Investigation
Detach these supplemental information instruction parts before submitting the attached form. Instructions for
completing this form (FAA 8710-1 form) are attached. 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 applicant’s social security number, telephone
number, and e-mail address are optional.
For faster processing, the FAA encourages applicants to apply online using the FAA Integrated Airman Certification
and Rating Application (IACRA). IACRA is available at https://iacra.faa.gov.

Tear Off this cover before submitting form.

i

FAA Form 8710-1, AIRMAN CERTIFICATE AND/OR RATING
APPLICATION
PRIVACY ACT STATEMENT: This statement is provided pursuant to 5 U.S.C. § 552(a):
The authority for collecting this information is contained in 49 U.S.C. §§ 40113, 44702, 44703, 44709, 44710, 44711 (a)(2)
and 14 CFR Part 61. The principal purpose for which the information is intended to be used is to identify and evaluate your
qualifications and eligibility for the issuance of an airman certificate and/or rating. A person holding a flight instructor
certificate also submits this form to the Administrator with documentation to identify and evaluate establishment of recent
experience (recency). Submission of the data is mandatory, except for the applicant's/individual’s social security number
which is optional. Failure to provide all required information will result in the FAA being unable to issue you a certificate
and/or rating, or accept a flight instructor’s submission to validate a new recency period. The information collected on this
form will be included in a Privacy Act System of Records known as DOT/FAA 847, titled “Aviation Records on Individuals”
and will be subject to the routine uses published in the System of Records Notice for DOT/FAA 847 (see
www.dot.gov/privacy/privacyactnotices), including:
(a) Providing basic airmen certification and qualification information to the public upon request. Examples of basic information
include:
•
The type of certificate(s) and/or rating(s) held, limitations, date of issuance and certificate number;
•
The status of the airman’s certificate (i.e., whether it has been amended, modified, suspended or revoked for
any reason);
•
The airman’s home address, unless requested by the airman to be withheld from public disclosure per 49 U.S.C.
44703(c);
•
Information relating to an airman’s physical status or condition used to determine statistically the validity of
FAA medical standards, the date, class, and restrictions of the latest physical;
•
Information relating to an individual’s eligibility for medical certification, requests for exemption from medical
requirements, and requests for review of medical certificate denials.
(b) Using contact information to inform airmen of meetings and seminars conducted by the FAA regarding aviation safety.
(c) Disclosing information to the National Transportation Safety Board in connection with its investigation responsibilities.
(d) Providing information about airmen to Federal, State, local and tribal law enforcement agencies when engaged in an official
investigation in which an airman is involved.
(e) Providing information about enforcement actions, or orders issued thereunder, to Federal agencies, the aviation industry, and
the public upon request.
(f) Making records of delinquent civil penalties owed to the FAA available to the U.S. Department of the Treasury and the U.S.
Department of Justice (DOJ) for collection pursuant to 31 U.S.C. 3711(g).
(g) Making records of effective orders against the certificates of airmen available to their employers if the airmen use the affected
certificates to perform job responsibilities for those employers.
(h) Making airmen records available to users of FAA’s Safety Performance Analysis System (SPAS), including the Department
of Defense Commercial Airlift Division’s Air Carrier Analysis Support System (ACAS) for its use in identifying safety
hazards and risk areas, targeting inspection efforts for certificate holders of greatest risk, and monitoring the effectiveness of
targeted oversight actions.
(i) Making records of an individual’s positive drug test result, alcohol test result of 0.04 or greater breath alcohol concentration,
or refusal to submit to testing required under a DOT-required testing program, available to third parties, including current and
prospective employers of such individuals. Such records also contain the names and titles of individuals who, in their
commercial capacity, administer the drug and alcohol testing programs of aviation entities.
(j) Providing information about airmen through the Civil Aviation Registry’s Comprehensive Airmen Information System to the
Department of Health and Human Services, Office of Child Support Enforcement, and the Federal Parent Locator Service that
locates noncustodial parents who owe child support. Records in this system are used to identify airmen to the child support
agencies nationwide in enforcing child support obligations, establishing paternity, establishing and modifying support orders
and location of obligors. Records listed within the section on Categories of Records are retrieved using Connect: Direct
through the Social Security Administration’s secure environment.
(k) Making personally identifiable information about airmen available to other Federal agencies for the purpose of verifying the
accuracy and completeness of medical information provided to FAA in connection with applications for airmen medical
certification.
(l) Making records of past airman medical certification history data available to Aviation Medical Examiners (AMEs) on a routine
basis so that AMEs may render the best medical certification decision.
(m) Making airman, aircraft and operator record elements available to users of FAA’s Skywatch system, including the Department
of Defense, the Department of Homeland Security (DHS), DOJ and other authorized Federal agencies, for their use in
managing, tracking and reporting aviation-related security events.
(n) Other possible routine uses published in the Federal Register (see Prefatory Statement of General Routine Uses for additional
uses (65 FR 19477-78) For example, a record from this system of records may be disclosed to the United States Coast Guard
(Coast Guard) and to the Transportation Security Administration (TSA) if information from this system was shared with either
agency when that agency was a component of the Department of Transportation (DOT) before its transfer to DHS and such
disclosure is necessary to accomplish a DOT, TSA or Coast Guard function related to this system of records.

ii

Your signature on this form (FAA Form 8710-1) acknowledges that you received the Pilot’s
Bill of Rights Written Notification of Investigation at the time of this application.

PILOT’S BILL OF RIGHTS WRITTEN NOTIFICATION OF INVESTIGATION
The information you submit on the attached FAA Form 8710-1, Airman Certificate and/or
Rating Application, will be used by the Administrator of the Federal Aviation Administration as
part of the basis for issuing an airman certificate and/or rating to you under Title 49, United
States Code (U.S.C.) section 44703(a), if the Administrator finds, after investigation, that you
are qualified for, and physically able to perform the duties related to the certificate and/or rating
for which you are applying. You also submit FAA Form 8710-1 with documentation to the
Administrator to identify and validate flight instructor recent experience (recency). Therefore,
in accordance with the Pilot’s Bill of Rights, the Administrator is providing you with this
written notification of investigation of your qualifications for an airman certificate and/or
rating, or flight instructor recency:
•

The nature of the Administrator’s investigation, which is precipitated by your submission of
this application, is to determine whether you meet the qualifications for the airman
certificate and/or rating you are applying, or flight instructor recency you are submitting, as
applicable, under Title 14, Code of Federal Regulations (CFR) part 61.

•

Any response to an inquiry by a representative of the Administrator by you in connection
with this investigation of your qualifications for an airman certificate and/or rating, or
flight instructor recency may be used as evidence against you.

•

A copy of your airman application file for this date is available to you upon your written
request addressed to:
Federal Aviation Administration
Airmen Certification Branch,
AFB-720 P.O. Box 25082
Oklahoma City, OK 73125-0082
(If you make a written request for your airman application file, please provide your full
name, date of birth or airman certification number for identification purposes, and the date
of application.)

iii

AIRMAN CERTIFICATE AND/OR RATING APPLICATION
INSTRUCTIONS FOR COMPLETING FAA FORM 8710-1
I. APPLICATION INFORMATION. Mark “X” in all appropriate blocks(s).

Block M3. Date Issued. Enter the date your pilot certificate was last issued.

Note: A person holding a flight instructor certificate also submits
this form to the Administrator with documentation to identify and
evaluate establishment of recent experience (recency).

Block N. Do You Hold, or Have You Ever Held a Medical Certificate? Mark
applicable boxes. If yes, complete blocks N1, N2, and N3.

Block N1. Class of Medical Certificate. Enter the class as shown on the

Please enter all dates in eight digits as MM/DD/YYYY.
Use numeric characters, (e.g. 01/01/2023).

Block A. Name. Enter full legal name (Last, First, Middle). If your full legal name is

more than 50 characters, use no more than one middle name for record purposes. Do not
change the name on subsequent applications unless it is done in accordance with 14 CFR
part 61.25. If you do not have a middle name, enter “NMN.” If you have a middle
initial only, indicate “Initial only.” Indicate if you are a Jr., II, or III.

Block B. Social Security Number. Enter either your 9-digit social security

medical certificate, (i.e., First, Second, or Third Class). If your most recent medical
certificate which was valid at some point after July 14th, 2006 has expired and you are
operating under BasicMed, enter “BASICMED” in this field.

Block N2. Name of Medical Examiner. Enter the medical examiner’s name
as shown on your medical certificate. If you are operating under BasicMed, leave
blank.

Block N3. Date Issued. Enter the date your medical certificate was issued. If you are
operating under BasicMed, leave blank.

number, “Do Not Use” or “None” if you are not a U.S. citizen. If entering a social
security number, only enter a 9-digit U.S. social security number (optional). See
supplemental Privacy Act Information.

Block O. Narcotics Drugs. Mark appropriate block. Only mark “Yes” if you have

actually been convicted. If you have been charged with a violation which has not been
adjudicated, mark “No.” Do not include alcohol offenses involving a motor vehicle mode of
transportation as those are covered on the FAA Form 8500-8, Medical application.

Block C. Date of Birth. Enter your date of birth in the following format:

MM/DD/YYYY. Check for accuracy. Verify that DOB is the same as it is on the
medical certificate.

Block D. Place of Birth. If you were born in the USA, enter the city and state where

you were born. If the city is unknown, enter the county and state. If you were born outside
the USA, enter the name of the city and country where you were born.

Block E1. Residential Address. Enter your complete residential address. This must
include street number, city, state, and zip code. If the applicant has a foreign address, the
country must be stated. If a residential address does not exist, a map or written directions
to the applicant’s physical residence must be attached to the application. Verify that the
numbers are not transposed.
Block E2. Mailing Address. Enter your mailing address, if different than block E1.

This may be a residence, post office box, rural route, flight school address, personal mail
box (PMB), commercial address, or other mail drop location, as applicable. The address
provided in block E2, if any, will be printed on the permanent airman certificate. If you
want your airman certificate mailed to an address other than provided in blocks E1 or E2,
you will need to provide instructions on a separate attachment or in the remarks section
of the form.

Block F. Citizenship/Nationality. Mark USA if you are a U.S. Citizen or

Block O1. Date of Final Conviction. If block “N” was marked “Yes” provide
the date of final conviction.

II. CERTIFICATE OR RATING APPLIED FOR ON BASIS OF: Block
A. Completion of Required Test.

1. Aircraft to be used. (If flight test required) – Enter the make and model of each

aircraft used or represented. If a flight simulation training device (FSTD) is used,
indicate Level of Device(s).
2. Total time in this aircraft and/or approved full flight simulator (FFS) or flight
training device (FTD) (Hrs.) – (2a) Enter the total Flight Time (2b) Enter Pilot-InCommand (PIC) Flight Time.

Block B. U.S. Military Competence Or Experience. Enter your branch of

service, date rated as a U.S. military pilot, and your rank or grade. In block 4a and 4b,
enter the make and model of each military manned aircraft used to qualify (as
appropriate). ATD, FTD, or FFS time cannot be used.

Block C. Graduate of an Approved Course.
1. Name, Location, Certification Number of Training Agency/Center, as shown on the
graduation certificate. Indicate if this was a part 142 training center.

legally naturalized U.S. Citizen. If you are not a U.S. citizen, mark “Other” and enter
the country where you are a legal citizen. To claim Dual Citizenship the applicant
must present appropriate documentation of citizenship for each country.

2. Curriculum From Which Graduated. Enter name of curriculum and level,
category, and/or type rating, as applicable.

Block G. Do you read, speak, write and understand the English language?
Mark yes or no. If you answered “No” and it is due to medical reasons, an operating
limitation will be placed on the airman certificate.

Block H. Height. Enter your height in inches. Example: 5’8” would be entered as
68 in. No fractions, use whole inches only.

3. Date. Date of graduation from indicated course.
Note: Approved course graduate must also complete block A “Completion of
Test or Activity,” if the course is not part of an Air Agency or a part 142
Training Center.

Block D. Holder of Foreign License.
1. Country that Issued the Foreign Pilot License.
2. Grade Of Foreign Pilot License (i.e. private, commercial, etc).
3. Number. Number which appears on the foreign license.
4. Ratings. Enter the FAA equivalent only ratings that appear on the foreign license.

Block I. Weight. Enter your weight in pounds. No fractions, use whole pounds

only.

Indicate the ratings as they will appear on the FAA Certificate (i.e. ASEL, AMEL,
ROTORCRAFT HELICOPTER, CE-500, etc).

Block J. Hair Color. Spell out the color of your hair. Choose from the following:

bald, black, blond, brown, gray, red or white. If you wear a wig or toupee, enter the color
of your hair under the wig or toupee.

Block E. Completion of Air Carrier’s Training Program.
1. Name of air carrier.
2. Date program was started.
3. Identify the training program accomplished.

Block K. Eye Color. Spell out the color of your eyes. Choose from the following:
black, blue, brown, gray, green, or hazel.

Block L. Sex. Mark either Male or Female as appropriate.

III. RECORD OF PILOT TIME. At a minimum, the applicant should complete the

Block M. Do You Hold or Have You Ever Held An FAA Pilot
Certificate? Mark yes or no. (NOTE: A student pilot certificate is a pilot

blocks applicable to the certificate or rating sought; however, it is recommended that all
pilot time be entered. If decimal points are utilized, ensure that they are legible. Time
entered in the “Class Totals” block should reflect time in aircraft class for the certificate
or rating sought with this application. The time entered for an FFS, FTD, and/or ATD
may be credited towards the total time in the category, class, and instrument time as
permitted by the regulations. Add any Flight Engineer time used for ATP in remarks
section.

certificate.) If. Yes, complete Blocks M1, M2, and M3.

Block M1. Grade of Certificate. Enter the grade of the FAA pilot certificate

you hold (i.e., Student, Recreational, Private, Commercial, or ATP). DO NOT
enter flight instructor certificate information.

IV. HAVE YOU PREVIOUSLY RECEIVED A NOTICE OF

Block M2. Certificate Number. Enter your current FAA certificate number as it

DISAPPROVAL OR BEEN DENIED FOR ANY REASON
FOR THE CERTIFICATE AND/OR RATING
FOR WHICH YOU ARE APPLYING? Mark “Yes” or “No” as

appears on the pilot certificate.

appropriate.

V. APPLICANT’S/INDIVIDUAL’S CERTIFICATION.
A. Signature. Sign your name.
B. Date. The date you signed the application.

iv

OMB CONTROL NUMBER: 2120-0021
EXPIRATION DATE: 08/31/2025

TYPE OR PRINT ALL ENTRIES IN INK

Airman Certificate and/or Rating Application
I. APPLICATION INFORMATION (Mark ‘X’ in all the blocks applicable to the certificate or rating for which you are applying or for the information you submit to validate certain certification requirements)
Certificates
Ratings
Flight Instructor Recency/Other Information/Requests
Pilot:
Student
Private
ATP-Restricted

Instructor: Category and/or Class:
ASE
AME
Flight
Helicopter
Balloon
Commercial
Ground
Gyroplane
Airship
ATP
Type Rating:

Land
Sea
Glider
Powered-Lift
Added Rating

Recreational

A. Name (Last, First, Middle)

C. Date of Birth

Reexamination

Instrument Proficiency Check

Recency

Reissuance

Medical Flight Test

Reinstatement

Flight Review

Limitation Removal
IPL

D. Place of Birth (City and State) or (City and Country)

MM/DD/YYYY

E2. Mailing Address (This address will be printed on the
permanent airman certificate, if different than block E1.)

(Including City, State, Zip Code, and Country)

Initial

Specify other:

B. SSN (US Only)

E1. Residential Address

M.

Instrument:
Ground Instructor:
Airplane
Basic
Helicopter
Advanced
Powered-Lift
Instrument

F. Citizenship / Nationality
USA
Other

G. Do you read,
Yes
speak, write, &
understand the
specify:
No
English language?
H. Height I. Weight J. Hair Color K. Eye Color L. Sex
(inches)
(pounds)
Male
Female
M2. Certificate Number
M3. Date Issued

M1. Grade of Certificate
Yes
No (Note: A student pilot certificate is a pilot certificate.)
N. Do you hold, or have you ever held a Medical Certificate?
N1. Class of Certificate N2. Name of Medical Examiner
Yes - FAA
Yes - Foreign
Yes- Military
No
O. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances? Do not include alcohol offenses
involving motor vehicle mode of transportation as those offenses are covered on the FAA Form 8500-8, Airman Medical Application Form.
Yes
No
Do you hold, or have you ever held an FAA pilot certificate including revoked certificates?

N3. Date Issued
O1. Date of Final Conviction

II. CERTIFICATE OR RATING APPLIED FOR ON BASIS OF:
2. Total time in this aircraft and/or a. Flight
b. As Pilot-inCompletion of 1. Aircraft to be used (If flight test required)
A
approved FFS or FTD (hours):
Time
Command
Test or Activity
1. U.S. Military Service
2. Date Rated in U.S. Military
3. Rank or Grade
U.S. Military
B Competence or 4. List Military aircraft a. logged pilot time or provided flight instruction (IP) (make and
b. passed an Instrument Proficiency Check (Pilot or CFI) - (make and model)
Experience
for which you have: model)
1.Training Agency
1a. Name
Graduate of an or Training Center:
C Approved
2. Curriculum From Which Graduated
Course

D

Holder of
Foreign
License

1b. Location (City and State)

1d. Part 142?
Yes
No
3. Date

(Level, Category, and Class and/or Type Rating)

1. Country that Issued the Foreign Pilot License

2. Grade of Foreign Pilot License

3. Foreign Pilot License Number

4. Ratings Held on Foreign Pilot License (FAA equivalent only – e.g. ASEL, AMEL, Type rating, etc.)

Air Carrier
1. Name of Air Carrier
Training
Program
III. RECORD OF PILOT TIME (Do not write in the shaded areas)

2. Date Training Began 3. Accomplished Training Program
Initial
Upgrade
Transition

E

Total

1c. Certification Number

Instruction
Received

Solo

Airplanes
Rotorcraft
Powered
Lift

Gliders
Lighter­
Than-Air

PIC
and SIC

Cross Country
Cross Country Cross Country
Instruction
Instrument
Solo
PIC/SIC
Received

Night
Instruction
Received

Night TakeOff /
Landing

Night
PIC/SIC

Night Take­
Off/Landing
PIC/SIC

PIC

PIC

PIC

PIC

SIC

SIC

SIC

SIC

PIC

PIC

PIC

PIC

SIC

SIC

SIC

SIC

PIC

PIC

PIC

PIC

SIC

SIC

SIC

SIC

Recurrent

Number of
Flights
Gliders

PIC

Aero-Tows

Ground
Launches

Powered
Launches

Dual

Lighter-thanair

Class Totals
SEL
Airplane

PIC

MEL

SES

MES

PIC

PIC

PIC

PIC

SIC

SIC

SIC

SIC

Instruct Rcvd

Instruct Rcvd

Instruct Rcvd

Instruct Rcvd

Helicopter

Gyroplane

Balloon

Airship

Rotorcraft

SIC
PIC

PIC

PIC

PIC

SIC

SIC

SIC

SIC

Lighter-thanair

FFS

FFS

FTD

FTD

ATD

ATD

IV. Have you previously received a Notice of Disapproval or been denied for any reason for the certificate AND/OR rating for which you are applying?

Yes

SE

ME

Helicopter

No

V. APPLICANT’S CERTIFICATION: I certify that all statements and answers provided by me on this form are complete and true to the best of my knowledge. I agree that they are to be considered as part of the basis for issuance of
any FAA certificate to me or to validate my recency. I have received the Pilot’s Bill of Rights Written Notification of Investigation that accompanies this form. I have also read and understand the Privacy Act statement that accompanies this form.
Signature of Applicant/Individual
FAA Form 8710-1 (10-22) Supersedes Previous Edition

Date

MM/DD/YYYY

Page 1 of 2

OMB CONTROL NUMBER: 2120-0021
EXPIRATION DATE: 08/31/2025

Instructor Action
☐ Accepted Student Pilot Application – I have personally reviewed the applicant’s information and verified the person meets the eligibility requirements and verified applicants identification
☐

Flight Review

Date

☐

Instrument Proficiency Check

☐

☐ Rejected Student Pilot Application

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

Authorized Flight Instructor’s Signature (Print Name and Sign)

Flight Instructor Certificate Number

Certificate Expiration Date

Air Agency’s Recommendation
The applicant has successfully completed our
Date

course, and is recommended for certificate or rating without further practical test.

Agency Name and Number

Official Signature

Designated Examiner or Airman Certification Representative Report
Accepted Student Pilot Application
☐ Rejected Student Pilot Application
☐ I have personally reviewed this applicant’s pilot logbook and/or training record, and I certify that the individual meets the applicable requirements of 14 CFR Part 61 for the certificate 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. (Original ATP CTP graduation certificate must be attached)
☐ I have personally tested and/or verified this applicant in accordance with pertinent procedures and standards with the result indicated below.
☐

I have personally delivered the Written Notification under the Pilot’s Bill of Rights to the applicant.
Approved – No Temporary Certificate Issued
☐ Approved – Temporary Certificate Issued (Original Attached) ☐ Disapproved – Disapproval Notice Issued (Original Attached)
Duration of Test
Location of Test (Name of Facility or Airport, City, State)
Ground / Oral
FFS / FTD
Flight
☐

Certificate or Rating Being Applied For (Grade, Category, Class and/or Type Rating)
Date

Type(s) of Aircraft Used

Examiner’s Signature (Print Name & Sign)

Registration Number(s)

Certificate Number

Designation Number

Designation Expires

Evaluator’s Record (Use for All ATP Certificate(s) and/or Type Rating(s))

Inspector

Examiner

Signature and Certificate Number

Date

Ground / Oral
Approved FFS/FTD Check
Aircraft Flight Check
Advanced Qualification Program

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. (The approved box need only checked if the Inspector is the one that issued the temporary airman certificate)
☐ I have personally delivered the Written Notification under the Pilot’s Bill of Rights to the applicant.
☐ Approved – No Temporary Certificate Issued
☐
Approved – Temporary Certificate Issued (Original Attached)
☐ Disapproved – Disapproval Notice Issued (Original Attached)
☐ Accepted - Student Pilot Application
☐ Rejected - Student Pilot Application
Duration of Practical Test
Location of Test (Name of Facility or Airport, City, State)
Ground / Oral
FFS / FTD
Flight
Certificate or Rating Being Applied For (Grade, Category, Class and/or Type Rating)

Type(s) of Aircraft Used

Registration No.(s)

Certification Activities:

Certificate or Rating Based on:

Examiner’s Recommendation Provided/Reviewed
Accepted

Rejected

Application for Student Pilot Certificate Accepted
Reissue or exchange of pilot, CFI, or G.I. certificate
Change of name, nationality, gender or date of birth

Ground Instructor Certificate Issued
Basic
Advanced
Instrument

SIC Type Rating issued under § 61.55(b) (Part 91)

Training Course (FIRC) Name
Date

Approved FAA Qualification Criteria not Identified on Page 1

Flight Instructor Certificate
Initial Added Rating Recency Reinstatement

Instructor Recency Based On:
Activity

Training Course

Test

Duties and Responsibilities

Military Instructor Proficiency Check

Graduation Certificate Number

Certifying Statement
College Transcript (Official)
ATP CTP Graduation Certificate
Knowledge Test Report
Temporary Airman Certificate
Notice of Disapproval
Superseded Airman Certificate

Foreign License

Special medical test conducted – report forwarded
to issuing medical office or AAM-300
Special Test-Reexamination (44709) conducted
Approved

Certificate Number

FAA Office (e.g. SO-15, WP-19)

Airman’s Identification (ID) (US driver’s license or passport recommended)

Applicant Information (required if printed on 2 pages)

Form of ID

Name

ID Number (If issued by State, include State)

Date of Birth

Expiration Date (must be valid)

Certificate Number

Telephone Number

E-Mail Address

Meets Aviation English Language Standard
REMARKS:

FAA Form 8710-1 (10-22) Supersedes Previous Edition

Disapproved

Date of FIRC Graduation Certificate

Inspector’s Signature (Print Name & Sign)

Attachments:

WINGS

Military Competency

Does Not Meet Aviation English Language Standard

Referred to FSO for Aviation English Language
Standard Determination

Page 2 of 2