Request an Appointment - Norcal DPE Services

Applicant Name

Applicant Telephone #

Applicant E-mail

Certificate or Rating Sought

Applicant FTN

Aircraft Make and Model

Primary Training Airport

Applicant Certificate #

14 CFR Part

US Citizen

Is this a Re-Examination? **(A re-examination from another DPE will be a Full Test, Full Fee)**

Recommending CFI's Name

Recommending CFI's Telephone #

Recommending CFI's E-mail

a CFI's be

Recommending CFI's Certificate #

Comments

Acknowledgements – Required to Check ALL

I understand this is a request and NOT a confirmation of a Practical Test or Date.
I confirm I meet all requirements for the certificate I am seeking and I have been properly endorsed for the practical test.
I conifrm I understand I will be tested in accordance with the current appropriate Airmen Certification Standards and am intimately familiar with these Standards
I confirm and accept that I am the Pilot in Command for the Practical Examination
I accept ALL liability for the aircraft and persons/property in the air or on the ground for the Checkride and shall defend and hold harmless the Examiner from any actions that may result from the checkride
I (JS) only conduct Re-Examinations or Discontinuances initially conducted by me. Any scheduled test not completed successfully with another DPE will be a full practical test and fee.