United States Department of Veterans Affairs (VA)

PART I – FACILITY INFORMATION

Date: Name of School: Mailing Address: Physical Address: Chief Administrative Officer/Title: Name/Title of Contact: Tel. # Fax # Email Address:

School is organized as: Public Entity (City, State, or Federal) Non-Profit Corporation Other (specify) ______Accreditation Status: Accredited (Provide name of accrediting agency below) ______

Expiration Date of Accreditation: ______Non-accredited

Facility is: Institution of Higher Learning Apprenticeship High School Flight School Other: Licensure Test (Federal, State or Local Govt)

Comments: ______

August 2011 Page 1 FLIGHT SCHOOLS

*Attach additional pages if required Are you reporting changes to your air agency certificate or FAA approval? Yes No If yes, notify your SAA also

If yes, explain:

Are you removing a program or aircraft? Yes No

If yes, list and attach a copy of the FSDO – stamped Training Course Outline (TCO) and complete next page

I Are you adding a new program? Yes No

If yes, explain and attach a copy of the FSDO – stamped TCO and complete next page

Are you modifying an existing program? Yes No If yes, explain and attach a copy of the FSCO-stamped TCO, if applicable and complete next page

Are you reporting other changes? Yes No If yes, please specify change(s) and complete next page as appropriate

August 2011 Page 2 NAME OF PROGRAM(s)

EFFECTIVE DATE (NEW ______) (EXISTING ______)

What is the change or revision? New rating(s) or revising of existing rating(s)

Please include a copy of your most recent flight school catalog and other forms VA students would be provided or required to complete when enrolling at your facility.

1. Updated FAA Air Agency Certificate to identify new ratings as Part 141

2. Complete information of hours of instruction (dual, solo, ground school, pre or post flight, simulator etc.

3. Aircraft Tail Numbers and horsepower for each aircraft used for this rating.

4. Location of aircraft

5. Are all aircraft owned or leased by school? If no provide specific information on aircraft not owned by school used for training (ex: leaseback etc)

6. Cost per hour for dual and solo for each Aircraft horsepower used.

7. Cost per hour for ground school, simulator, pre or post flight instruction

Revised:

Is the revision for modifying aircraft used for ratings? If so provide details that support FAA 141 Air Agency Certificate approval.

Is the revision for general price increase for instruction?

If so provide effective date of rate increase (use first day of month) and include all amounts (i.e. dual, solo for each type horsepower aircraft with identifying aircraft tail numbers, ground school, pre and post flight instruction, or simulator.

NOTE: VA does not approve vocational flight training for private pilot license training

August 2011 Page 3