PEQ 1.0

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Pilot Experience Questionaire (PEQ)

PILOT / OWNER INFORMATION

Pilot First Name

Pilot Middle Name

If no middle name then type "NMN"

Pilot Last Name

Pilot's Street Address

City

State

Zip Code

Pilot's Best Phone Number

Pilot's Email

FAA Pilot Certificate No.

Pilot's Date of Birth

mm/dd/yy

FAA Certificate Level

Is the pilot a U.S. Citizen?

YES NO

Type of FAA Pilot Certificate

Is the pilot to be trained above also the owner?

YES NO

Owner First Name

Owner Last Name

Owner's Best Phone Number

Owner's Email

Is the pilot to be trained responsible for payment?

YES NO

Responsible Party Name

First and Last Name of Responsible Party if an individual, otherwise Business Name

Responsible Party Mailing Address

City

State

Zip Code

Responsible Party Best Phone Number

Reponsible Party Email

TRAINING INFORMATION

What Type of Training do you desire?

Explain "Other" in special training requests below

What level of Type Rating certificate?

What Airport(s) do you plan to base your training out of?

What is the name of the FBO you want to use?

Do you have any special training requests?

AIRCRAFT INFORMATION

Type Aircraft

Model of Eclipse

Aircraft Tail Number

Aircraft Serial Number

Aircraft Insurance Company

PILOT EXPERIENCE

What FAA fixed-wing pilot certificates do you now hold?

Check all that apply

Do you have at least 50 hours of Garmin G1000 or G3000 flight experience?

Yes No

Do you have 25 hours of single pilot PIC time in a turbine aircraft with a glass cockpit and an FMS navigator?

Yes No

Are you or have you been a competition aerobatic pilot or a military pilot in a fighter-type aircraft?

Yes No

Have you ever received upset recovery training from a formal in-aircraft training program?

Yes No

Name and Location of Upset Recovery School

Total Flight Times

Approximate total time (PIC/SIC) in all airplanes?

Hours, numbers only

Approximate total time in the last 6 months?

Hours, numbers only

Approximate time in type aircraft to be trained in?

Hours, numbers only

Pilot-In-Command (PIC) Totals

TurboJet Aircraft?

Hours, numbers only

TurboJet last 6 months?

Hours, numbers only

Turbo-prop Aircraft?

Hours, numbers only

Turbo-prop last 6 months?

Hours, numbers only

Approximate military PIC time?

Hours, numbers only

Approximate Glass Cockpit PIC time?

Hours, numbers only

Approximate Single-Pilot turbine time?

Hours, numbers only

What models of aircraft comprise the majority of your flight experience?

List aircraft from most hours to least

Are you instrument current (recent instrument experience or recent IPC)?

Yes No

What is the total number of instrument approaches flown as sole manipulator of the controls within the last 90 days?

Numbers Only

Do you have the required training and logbook endorsements (or certificates) for:

High Altitude Endorsement Training?

Yes No

RVSM Operations?

Yes No

Please list any additional pilot experience not noted above:

By pushing the "Submit" button, you are certifying that all the information on this form is accurate and verifiable by logbooks or other records upon request.