Checkride Intake Form | Riemer & Associates

1Basic Info

2Credentials

3Checkride Info

4Policies

Basic Info

Name

First Middle Last

Address

Street Address Address Line 2 City State ZIP Code

Phone

Credentials

Certificate Number

IACRA FTN

IACRA Application ID Number

Recommending Instructor's Name

First Last

Recommending Instructor's Certificate Number

Recommending Instructor's Email Address

Recommending Instructor's Phone Number

Aircraft Make and Model

Aircraft N-Number

Aircraft Avionics

Checkride Info

Airport Where Checkride Will Be Conducted (3 Letter ID)

Facility Name Where Check Ride Will Be Conducted (FBO)

Facility Address Where Check Ride Will Be Conducted (Street, City, State, Zip Code)

Street Address Address Line 2 City State ZIP Code

Checkride Requested Date

MM slash DD slash YYYY

Check Ride Show Time

Hours

Minutes

AM/PM

Cross Country Flight I Assigned You

Knowledge Exam Date

MM slash DD slash YYYY

Knowledge Exam Grade

Evaluation Type:

Part 61

Part 141

Private ASEL

Commercial ASEL

Instrument Airplane

Add-on Certificate or Rating

Other

Additional Comments

For Part 141 Graduation Certificate Date

MM slash DD slash YYYY

CFI Endorsements & IACRA Form Completed

Yes

CFI Endorsement/IACRA Completion Date

MM slash DD slash YYYY

Flight Training Facility Name

Flight Training Facility Address

Street Address Address Line 2 City State ZIP Code

Notice of Disapproval Date (if Applicable)

MM slash DD slash YYYY

Letter of Discontinuance (if Applicable)

Yes

Letter of Discontinuance Date (if Yes)

MM slash DD slash YYYY

DPE Name (if not me)

DPE Location (City, State)

City State

GPS Database Current

Yes

iPad Database Current

Yes

Policies & Procedures

Review and check off each item below.

Policies & Procedures(Required)

If scheduling a morning checkride the start time should be 9am, unless otherwise agreed to by DPE

If scheduling an afternoon checkride the start time should be 12pm (noon), unless otherwise agreed to by DPE

Plan for a six-hour block of time to complete checkride

Review and complete the Applicant’s Practical Test Checklist. Click here to download.

Bring all requested items with you to the checkride

Bring ALL of your logbooks to show your times and endorsements. If you use an electronic logbook printout a hardcopy of the flights and required endorsements (TSA, Solo, Cross Country, etc)

Review endorsement for compliance with Advisory Circular 61.65H

Have access to ALL weather charts & information applicable to planning your flight

Printout all performance charts used in calculations for the checkride to include weight & balance, takeoff data, climb, cruise, landing data

Calculate Va for our flight (Use my provided weight from when we talked)

Email/Text me jriemer@riemerco.tempurl.host/703-859-2807 a PDF copy of your Knowledge Exam results & Part 141 Graduation Certificate as applicable (at least three days before the flight)

Bring original Knowledge Exam results & Part 141 Graduation Certificate, as applicable to the Checkride

Private Pilot Applicants – If your checkride is being accomplished at an airport other than your home base, please ensure you have the appropriate endorsement(s) in your logbook

If you are a Foreign National Applicant, bring your Original Passport, Visa, & Green Card as applicable. Copies are not accepted. Three days prior to your scheduled checkride, email me a copy of your Part 141 Graduation Certificate (if applicable), TSA Approval Letter-Email

Checkride fee for Private ($650), Commercial ($650), Instrument ($650)

There is a $200 deposit required when scheduling the checkride. This is non-refundable. It will be credited to the checkride fee when doing your checkride

Canceling your checkride – Call me and speak to me (NO TEXTING OR VOICEMAILS FOR CANCELATIONS). Day prior up to 10pm, or earlier if at all possible, or NLT 2 hours prior to the show time on the day of the checkride, if you are unable to fly the checkride. If your checkride is at other that KDTS, KCEW, or KVPS, check with me when scheduling the checkride for a different notification time. Failure to cancel by the specified time, will result in a $125 per hour fee for the time I spend traveling to and waiting for you to show up for the checkride.

Once the checkride begins the Full Checkride Fee will apply. If you receive a Notice of Disapproval and the retest is scheduled within 60-days there will be a minimum fee of $250 for the retest, plus travel. If the retest takes longer than two-hours there will be an additional $125 per hour for the retest. If the retest is scheduled beyond 60 days from the Notice of Disapproval, the entire test must be re-accomplished and the full fee of $650, plus travel will be charged.

Travel fee for checkrides at locations other than KDTS, KVPS, or KCEW is $0.90 cents per mile driving distance round trip

Bring a (two sided Front & Back) completed paper original 8710 signed by your instructor. I CANNOT accept your paper 8710 if printed on two pieces of paper because your name is not located anywhere on the back page. In the event IACRA is down, we will use the paper 8710. You may use the IACRA (view/print) copy that has been electronically signed by your Flight instructor. There will be an additional $100 fee for the use of a paper 8710 submission. In IACRA, choose the “DO NOT USE” in the drop-down menu of the SSN Block

Balance of Payment is due upon commencement of the exam. Payable with Credit Card, Pay Pal, Venmo, ACH, or cash.

If you receive a Letter of Discontinuance, it is good for 60-days, all documents must be current, and the only charge will be travel fee if applicable. No additional fee for checkride. If over 60-days the full fee of $650, plus travel will be charged

Thank you for the opportunity to help you achieve your goal!

Intake Questionnaire

Basic Info

Credentials

Checkride Info

Policies & Procedures