Pilot History Form Download PDF Form Back to ‘Forms’ First Name* Last Name* Phone* Street Address* City* State*—Please choose an option—ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY ZIP/Postal Code* Certificate*Student PilotPrivate PilotCommercialATPCFICFIIOther Ratings*Instrument-AirplaneInstrument-RWSELSESMELMESRW Medical Class* Medical Date* Certificate/Medical Limitations & Waivers* In the past 5 years have you been involved in an insurance claim, aviation incident, aviation accident whether covered by insurance or not?*YesNo In the past 5 years have you been subjected to any FAA enforcement?*YesNo In the past 5 years have you been convicted of a felony or DUI/DWI?*YesNo In the past 5 years have you had your Driver’s License suspended?*YesNo Total Logged Flight Hours* Total Hours in Last 12mo.* Cessna 150 Total Hours* Cessna 150 Hours in Last 12mo.* Cessna 172 Total Hours* Cessna 150 Hours in Last 12mo.* Piper PA-28 Total Hours* Piper PA-28 Hours in Last 12mo.* Do you have additional experience to add?YesNo Additional Experience Type* Add. Exp. Total Hours* Add. Exp. Hours in Last 12mo.* Do you have additional experience to add?YesNo Additional Experience Type* Add. Exp. Total Hours* Add. Exp. Hours in Last 12mo.* Formal Training Received Date Location Latest Flight Review Type Latest Flight Review Date Δ