* denotes a required field

*Name of person completing this form:

UIN (if applicable):

*Phone number:

*Email:

Pilot information

Skip this section if the pilot information is the same as the person completing this form.

Pilot's name:

Pilot's UIN (if applicable):

Pilot's phone number:

Pilot's email:

Flight information

*Date(s) and time(s) of flight (list each day/time you plan on flying):

*Location of flight:

*Max height of flight:

*Purpose of flight:
Hobby/recreationResearchCommercialOther (please specify below)

If you selected research or commercial purposes, please provide more detail on the campus unit with which you are affiliated and the specific purpose of your flight.

Acknowledgements

*Is your drone registered with the FAA?
YesNoMy drone does not require FAA registration (please indicate make and model below)

If you answered yes to the previous question, please list your drone's FAA registration number here:

*Drone serial number:

*Does the pilot have FAA Part 107 certification?
YesNo

If you answered yes to the previous question, please list the pilot's certificate number and date of issue:

*Has the pilot reviewed and does the pilot understand the Academy of Model Aeronautics safety guidelines?
YesNo

*Has the pilot reviewed and does the pilot understand all FAA requirements?
YesNo

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