AC 61-65F

Historical

Advisory circular · Certification: Pilots and Flight and Ground Instructors

A newer version is currentThis is a historical version. AC 61-65K is the version in force, approved November 14, 2025.
Approved
February 25, 2016
Last reviewed
June 27, 2024
Cancelled by
AC61-65G
Family
AC 61-65 · 9 versions
Revision
F
14 CFR parts
61, 63, 65, 121, 135, 133, 142, 91

Guidance, not mandatory unless a rule or AD requires it. DRS record last changed November 21, 2025.

Show pages 13–24

Par 30 Page 21 completes the requirement(s) for renewal within the 3 calendar-months prior to the month of expiration.

(3) If the flight instructor certification renewal action occurs outside the 3 calendar-month period of the expiration month on the flight instructor certificate, the renewed flight instructor certificate will be valid for 24 calendar-months from the month the renewal requirements of § 61.197 were accomplished. A FIRC graduation certificate must be presented to a FSDO within 3 calendar-months of completion of the FIRC. The renewal action of § 61.197(a) must be accomplished before the expiration date shown on the applicant’s flight instructor certificate.

NOTE: If a FIRC is completed more than 3 calendar-months prior to the expiration month of the current flight instructor certificate, the expiration date will be the date that the FAA Form 8710-1 application is submitted to the FAA, provided the application is submitted within 3 calendar-months of completion of the FIRC.

d. The following examples might help explain how to determine the date from which the 24-month renewal flight instructor certificate should be dated.

(1) In example 1, the flight instructor completes the FIRC within the 3 calendar-months preceding the expiration date of the current certificate and files an FAA Form 8710-1 application to renew the certificate within 3 calendar-months of the date of graduation from the FIRC course.

In this example, the CFI would get a new certificate with a new expiration date of 24 months from the date of expiration of his current certificate, as prescribed in § 61.197(b)(2)(ii).

(2) In example 2, the flight instructor has a certificate with an expiration date of August 31, 20xx. The FIRC is completed on January 5, 20xx, 7 months before the expiration date of the current certificate. The flight instructor applies for renewal of the certificate on April 13, 20xx, within 3 calendar-months of the date of the FIRC graduation. The flight instructor would receive a new certificate with an expiration date of 24 months from April 30, 20xx, or in other words, April 30, 20x2.

(3) In example 3, the flight instructor has a certificate with an expiration date of August 31, 20xx. The flight instructor completes the FIRC on March 7, 20xx, and applies for renewal of the certificate on June 2, 20xx. This is within 3 calendar-months of the date of the FIRC graduation and within 3 calendar-months of the expiration date of the current certificate.

In this case, the flight instructor would receive a new certificate with an expiration date of 24 months from the date of application, or in other words, an expiration date of June 30, 20x2.

This is because even though the application is dated within 3 calendar-months preceding the date of expiration of his or her current certificate, the FIRC was not completed within the 3 calendar-months preceding the date of expiration of his or her certificate, as is required under § 61.197(b)(2)(ii).

Par 30 Page 22 NOTE: If you wish to retain the month of expiration of your flight instructor certificate, it is recommended that you complete the renewal requirements and submit your renewal application within the 3 months prior to the month of expiration of your certificate.

e. There have been several inquiries asking about the intent of the phrase “or other documentation acceptable to the Administrator” in § 61.3(d). During the flight instructor certification renewal process, when a FIRC graduation certificate is used for renewal and the applicant’s flight instructor certificate is being processed for renewal, a copy of the FIRC graduation certificate is considered “acceptable documentation to the Administrator” until the applicant receives his or her permanent flight instructor certificate. Another example of other “acceptable documentation to the Administrator” is a copy of the flight instructor renewal application that the applicant has completed and signed FAA Form 8710-1.

f. Regardless of what has been explained in the paragraphs above, it should be understood that the FAA has the prerogative to require any applicant to complete a part or the entire applicable flight instructor practical test. A practical test may be required if there is reason to believe that it will correct some deficiency in the applicant’s instructing abilities or it has been determined necessary to introduce new training procedures or certification requirements.

31. EXPIRED FLIGHT INSTRUCTOR CERTIFICATE. The requirements for holders of an expired flight instructor certificate to obtain a new certificate are located in § 61.199. A practical test is required in the exchange of an expired flight instructor certificate. A DPE or an ASI will not reinstate expired flight instructor certificates unless the applicant passes a practical test or the applicant meets the requirements of SFAR 100-2.

a. The holder of an expired flight instructor certificate (i.e., a flight instructor certificate that conforms to § 61.5(c)) may exchange that certificate for a new certificate (except for a flight instructor certificate with a sport pilot rating) by passing one practical test, per § 61.183(h), for one of the aircraft ratings held on that person’s expired flight instructor certificate.

NOTE: If the practical test is for a flight instructor certificate with a sport pilot rating, the examiner may only issue that rating and provide endorsements for the category and class privileges tested.

b. Flight instructor ratings or limited flight instructor ratings on a pilot certificate are no longer valid. To reinstate instructor privileges, all requirements for initial issuance of a flight instructor certificate must be met.

c. Relief for persons supporting U.S. Armed Forces operations, SFAR 100-2. FSDOs are authorized to accept an expired flight instructor certificate to show eligibility under § 61.197 for renewal of a flight instructor certificate from an eligible person that meets the requirements of SFAR 100-2. The eligible person must present the FSDO with the required documents along with FAA Form 8710-1.

32. INSTRUMENT RATING. Specific knowledge, flight proficiency, flight experience, and endorsement requirements for the instrument rating are located in § 61.65.

Par 33 Page 23

33. ADDITIONAL AIRCRAFT RATINGS (OTHER THAN ATP). Specific knowledge, flight proficiency, flight experience, and endorsement requirements for additional category, class, or type rating (for other than at the ATP level) are located in § 61.63.

a. Category and Class Ratings. Applicants adding a category and/or class rating to a recreational pilot certificate or higher, other than ATP, must have an instructor’s recommendations and appropriate endorsements. An applicant for, other than ATP Certificate with airplane category multiengine class rating, need not take an additional knowledge test, provided the person holds an airplane, powered-lift, rotorcraft, powered parachute, weight-shift-control aircraft, or airship rating at or above the pilot certificate level sought. An applicant must pass the required practical test appropriate to the pilot certificate for the aircraft category and, if applicable, class rating sought. Additionally, applicants must comply with the requirements of § 61.63, as noted below:

(1) Category Ratings. Applicants must receive the training and have the aeronautical experience required by part 61 that applies to the pilot certificate level for the category, and if applicable, class rating sought.

(2) Class Ratings. Applicants must be found competent in the knowledge areas and proficient in the areas of operation for the class rating sought.

(3) Type Ratings. Applicants must have the required training time, logbook, or training record endorsements, and pass the required practical test in accordance with the ATP/type rating ACS or PTS, as appropriate (refer to § 61.63(d)).

b. Experimental Category and Class Rating§ 61.31(l)(2)(iii)(B) for the Carriage of Passengers. An applicant holding at least a recreational pilot certificate may apply for the issuance of a category and class rating limited to a specific make and model of experimental aircraft in accordance with the provisions of § 61.63(h), with the limitation “Authorized Experimental Aircraft: [Category] and [Class] rating [Make] and [Model].” The applicant is required to receive a logbook endorsement from an authorized flight instructor who has determined that the applicant is proficient to act as PIC of the same category, class, make, and model of experimental aircraft for which the application was made. The 5 hours of flight experience must have been logged between September 1, 2004, and August 31, 2005. Once the pilot complies with the provisions of § 61.63(h), that pilot may be issued the appropriate category and class rating limited to a specific make and model of experimental aircraft.

34. ADDITIONAL CATEGORY/CLASS RATINGS AT THE ATP CERTIFICATION LEVEL.

a. Specific requirements for additional category, class, or type rating (at the ATP certification level) are located in § 61.165.

b. An instructor recommendation is not required, unless the applicant has failed the practical test and this is a retest (per § 61.49). Applicants for retest must comply with the appropriate retest requirements of § 61.49. In addition, the instructor must sign the applicant’s FAA Form 8710-1 application for the retest.

Par 34 Page 24 NOTE: If seeking to add airplane category and multiengine class rating to an ATP Certificate, the applicant must complete an approved ATP CTP in accordance with § 61.156 prior to taking the required knowledge test.

c. Experimental category and class rating. An applicant holding an ATP Certificate may apply for the issuance of an appropriate type rating if one has been established, and experimental aircraft authorization, by make and model, on their pilot certificate, or a temporary letter of authorization (LOA) issued by the FAA Flight Standards (AFS) Operations Inspector, as appropriate. The applicant may complete the appropriate aircraft type rating practical test in the subject aircraft. An applicant may also qualify for an additional aircraft category and class rating on his or her pilot certificate for an aircraft issued an experimental certificate in accordance with the provisions of § 61.165(g). If the applicant is unable to meet the requirements of paragraph (g), the applicant may apply in accordance with § 61.165(a) through (e), as applicable.

35. OTHER INSTRUCTOR ENDORSEMENTS. Specific requirements for knowledge, aeronautical experience and, as appropriate, testing for the complex airplane, high performance airplane, tailwheel airplane, high altitude/pressurized airplane, and type specific training are found in § 61.31.

36. GROUND INSTRUCTOR CERTIFICATION. The applicability, eligibility, privileges, and recency requirements for the ground instructor certificate is located in part 61 subpart I.

37. AUTHORIZED INSTRUCTORS. Section 61.1 defines an “authorized instructor” as:

a. A person who holds a ground instructor certificate issued under part 61 and is in compliance with § 61.217 when conducting ground training in accordance with the privileges and limitations of his or her ground instructor certificate;

b. A person who holds a flight instructor certificate issued under part 61 and is in compliance with § 61.197 when conducting ground training or flight training in accordance with the privileges and limitations of his or her flight instructor certificate; or

c. A person authorized by the Administrator to provide ground training or flight training under 14 CFR part 61, 121, 135, or 142 when conducting ground training or flight training in accordance with that authority. Section 61.41 authorizes certain instructors who are not certificated by the FAA to provide training. However, only instructors who are certificated by the FAA are allowed to provide the required endorsements toward the requirements for a pilot certificate, rating, or privilege issued under part 61.

38. ADDITIONAL TRAINING FOR GLIDERS. Specific knowledge, flight proficiency, and endorsement requirements for the ground tow, aerotow, and self-launch procedures for gliders are located in § 61.31(j).

a. Pilots who desire to use ground-tow launch procedures must have satisfactorily accomplished ground and flight training on ground-tow procedures and operations. The pilot must have received an endorsement from a CFI-Glider instructor who certifies, in the pilot’s logbook, that the pilot has been found proficient in ground-tow procedures and operations.

Par 38 Page 25 (and 26)

b. Pilots who desire to use aerotow procedures must have satisfactorily accomplished ground and flight training on aerotow procedures and operations. The pilot must have received an endorsement from a CFI-Glider instructor who certifies, in the pilot’s logbook, that the pilot has been found proficient in aerotow procedures and operations.

c. Pilots who desire to use self-launch procedures must have satisfactorily accomplished ground and flight training on self-launch procedures and operations. The pilot must have received an endorsement from a CFI-Glider instructor who certifies, in the pilot’s logbook, that the pilot has been found proficient in self-launch procedures and operations.

d. In accordance with § 61.31(j)(2), the holder of a glider rating issued prior to August 4, 1997, is considered to be in compliance with the training and logbook endorsement requirements of this paragraph for the specific operating privilege for which the holder is already qualified.

e. Prior to September 1, 2004, some weight-shift-control aircraft had been issued an experimental certificate in the glider category. In these cases only, initial pilot certification for the issuance of at least a private pilot certificate with a glider rating limited to weight-shift-control or glider-trike privileges was authorized.

NOTE: After September 1, 2004, issuance of at least a private pilot certificate with a glider rating limited to weight-shift-control or glider-trike privileges is no longer authorized, nor necessary, now that there are established training and certification requirements for weight-shift-control category aircraft under part 61.

f. Effective January 15, 2005, airmen who conducted their initial pilot certification in a weight-shift control aircraft that was certificated as an experimental aircraft in the glider category and received a private pilot certificate or higher with a glider rating limited to weight-shift-control or glider-trike privileges can apply using FAA Form 8710-11 at a FSDO for a weight-shift-control category and/or class rating to be added to their airman certificate with no further showing of competency.

39. WHERE YOU CAN FIND THIS AC. You can find this AC on the FAA’s Web site at http://www.faa.gov/regulations_policies/advisory_circulars.

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Appendix 1 APPENDIX 1. INSTRUCTOR ENDORSEMENTS

CONTENTS

No. Endorsement DescriptionPage

Prerequisites for the Practical Test Endorsements

1. Prerequisites for practical test: Title 14 of the Code of Federal Regulations (14 CFR)

part 61, § 61.39(a)(6)(i) and (ii)5

2. Review of deficiencies identified on airman knowledge test: § 61.39(a)(6)(iii)

as required5

Student Pilot Endorsements

3. Presolo aeronautical knowledge: § 61.87(b)5

4. Presolo flight training: § 61.87(c)5

5. Presolo flight training at night: § 61.87(c) and 61.87(o)6

6. Solo flight (first 90-day period): § 61.87(n)6

7. Solo flight (each additional 90-day period): § 61.87(p)6

8. Solo takeoffs and landings at another airport within 25 nautical miles (NM): § 61.93(b)(1)6

9. Solo cross-country flight: § 61.93(c)(1) and 61.93(c)(2)6

10. Solo cross-country flight: § 61.93(c)(3)6

11. Repeated solo cross-country flights not more than 50 NM from the point of

departure: § 61.93(b)(2)7

12. Solo flight in Class B airspace: § 61.95(a)7

13. Solo flight to, from, or at an airport located in Class B airspace: § 61.95(a)

and 14 CFR part 91, § 91.131(b)(1)7

14. Endorsement of a U.S. citizenship recommended by the Transportation Security Administration (TSA): Title 49 of the Code of Federal Regulations (49 CFR)

§ 1552.3(h)7

Additional Student Pilot Endorsements for Students Seeking Sport or Recreational Pilot Certificates

15. Solo flight in Class B, C, and D airspace: § 61.94(a)7

16. Solo flight to, from, or at an airport located in Class B, C, or D airspace or on an

airport having an operational control tower: §§ 61.94(a) and 91.131(b)(1)8

Sport Pilot Endorsements

17. Aeronautical knowledge test: §§ 61.35(a)(1) and 61.3098

18. Taking flight proficiency check for different category or class of aircraft:

§§ 61.309 and 61.3118

19. Passing flight proficiency check for different category or class of aircraft:

§§ 61.309 and 61.3118

20. Taking sport pilot practical test: §§ 61.309, 61.311, and 61.3138

21. Passing a sport pilot practical test: §§ 61.309, 61.311, and 61.3139

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22. Class B, C, or D airspace, at an airport located in Class B, C, or D airspace, or to,

from, through, or on an airport having an operational control tower: § 61.3259

23. Light-sport aircraft that has a maximum speed in level flight with maximum continuous power (VH) less than or equal to 87 Knots Calibrated Airspeed (KCAS):

§ 61.3279

24. Light-sport aircraft that has a VH greater than 87 KCAS: § 61.3279

Recreational Pilot Endorsements

25. Aeronautical knowledge test: §§ 61.35(a)(1), 61.96(b)(3), and 61.97(b)9

26. Flight proficiency/practical test: §§ 61.96(b)(5), 61.98(a) and (b), and 61.999

27. Recreational pilot to operate within 50 NM of the airport where training was

received: § 61.101(b)10

28. Recreational pilot to act as pilot in command (PIC) on a flight that exceeds 50 NM

of the departure airport: § 61.101(c)10

29. Recreational pilot with less than 400 flight hours and not logged PIC time within

the preceding 180 days: § 61.101(g)10

30. Recreational pilot to conduct solo flights for the purpose of obtaining an additional certificate or rating while under the supervision of an authorized flight

instructor: § 61.101(j)10

31. Class B, C, or D airspace, at an airport located in Class B, C, or D airspace, or to,

from, through, or on an airport having an operational control tower § 61.101(d)10

Private Pilot Endorsements

32. Aeronautical knowledge test: §§ 61.35(a)(1), 61.103(d), and 61.10511

33. Flight proficiency/practical test: §§ 61.103(f), 61.107(b), and 61.10911

Commercial Pilot Endorsements

34. Aeronautical knowledge test: §§ 61.35(a)(1), 61.123(c), and 61.12511

35. Flight proficiency/practical test: §§ 61.123(e), 61.127, and 61.12911

Airline Transport Pilot (ATP) Endorsements

36. Restricted privileges ATP Certificate: Airplane multiengine land rating, § 61.16011

37. ATP Certification Training Program (CTP): § 61.153(e)11

Instrument Rating Endorsements

38. Aeronautical knowledge test: §§ 61.35(a)(1), 61.65(a) and 61.65(b)12

39. Flight proficiency/practical test: § 61.65(a)(6)12

40. Prerequisites for instrument practical tests12

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Appendix 1 Flight Instructor (Other Than Flight Instructors with a Sport Pilot Rating) Endorsements

41. Fundamentals of instructing knowledge test: §§ 61.183(d)12

42. Flight instructor aeronautical knowledge test: §§ 61.183(f)12

43. Flight instructor ground and flight proficiency/practical test: § 61.183(g)12

44. Flight instructor certificate with instrument—(category/class) rating/practical

test: §§ 61.183(g), 61.187(a) and 61.187(b)(7)13

45. Spin training: § 61.183(i)(1)13

Flight Instructor with a Sport Pilot Rating Endorsements

46. Fundamentals of instructing knowledge test: § 61.405(a)(1)13

47. Sport pilot flight instructor aeronautical knowledge test: §§ 61.35(a)(1)

and 61.405(a)13

48. Flight instructor flight proficiency check to provide training if a different category

or class of aircraft(additional category/class): §§ 61.409 and 61.41913

49. Passing the flight instructor flight proficiency check to provide training in a different category or class of aircraft(additional category/class): §§ 61.409 and 61.41914

50. Flight instructor practical test: §§ 61.409 and 61.41114

51. Passing the flight instructor practical test: §§ 61.409 and 61.41114

52. Spin training: § 61.405(b)(1)(ii)14

Ground Instructor Endorsement

53. Ground instructor who does not meet the recent experience requirements:

§ 61.217(b)14

Special Federal Aviation Regulation (SFAR) 73 Endorsements

54. R22/R44 awareness training: SFAR 73, section 2(a)(1) or (2)15

55. R22 solo endorsement: SFAR 73, section 2(b)(3)15

56. R22 PIC Endorsement: SFAR 73, section 2(b)(1)(ii)15

57. R22 flight instructor endorsement: SFAR 73, section 2(b)(5)(iv)15

58. Flight review in an R22 helicopter: SFAR 73, section 2(c)(1) and (3)15

59. R44 solo endorsement: SFAR 73, section 2(b)(4)16

60. R44 PIC endorsement: SFAR 73, section 2(b)(2)(ii)16

61. R44 flight instructor endorsement: SFAR 73, section 2(b)(5)(iv)16

62. Flight review in an R44 helicopter: SFAR 73, section 2(c)(2) and (3)16

Additional Endorsements

63. Completion of a flight review: § 61.56(a) and 61.56(c)16

64. Completion of any phase of an FAA-sponsored Pilot Proficiency Program

(WINGS): § 61.56(e)17

65. Completion of an instrument proficiency check: § 61.57(d)17

66. To act as PIC in a complex airplane: § 61.31(e)17

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67. To act as PIC in a high performance airplane: § 61.31(f)17

68. To act as PIC in a pressurized aircraft capable of high altitude operations:

§ 61.31(g)17

69. To act as PIC in a tailwheel airplane: § 61.31(i)17

70. To act as PIC of an aircraft in solo operations when the pilot does not hold

an appropriate category/class rating: § 61.31(d)(2)18

71. Retesting after failure of a knowledge or practical test: § 61.4918

72. Additional aircraft category or class rating (other than ATP): § 61.63(b)

or 61.63(c)18

73. Type rating only, already holds the appropriate category or class rating

(other than ATP): § 61.63(d)(2) and 61.63(d)(3)18

74. Type rating concurrently with an additional category or class rating (other

than ATP): § 61.63(d)(2) and 61.63(d)(3)18

75. Type rating only, already holds the appropriate category or class rating

(at the ATP level): § 61.157(b)(1)19

76. Type rating concurrently with an additional category or class rating (at the

ATP level): § 61.157(b)(1)19

77. Launch procedures for operating a glider: § 61.31(j)19

78. Review of a home study curriculum: § 61.35(a)(1)19

79. Experimental aircraft onlyadditional aircraft category or class rating

(other than ATP): § 61.63(h)19

80. Experimental aircraft onlyadditional aircraft category or class rating ATP: § 61.165(f)20

81. Aeronautical experience creditultralight vehicles: § 61.5220

82. Endorsement required to provide training for night vision goggle (NVG)

operations: § 61.195(k)(7)20

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Appendix 1

INSTRUCTOR ENDORSEMENTS The following examples are recommended sample endorsements for use by authorized instructors when endorsing logbooks, or other means found acceptable to the Administrator for airmen applying for a knowledge or practical test, or when certifying accomplishment of requirements for pilot operating privileges. Each endorsement must be legible and include the instructor’s signature, date of signature, certificated flight instructor (CFI) or certificated ground instructor (CGI) certificate number, and certificate expiration date, if applicable. The purpose for this advisory circular (AC) is to provide guidance and to encourage standardization among instructors.

PREREQUISITES FOR THE PRACTICAL TEST ENDORSEMENTS

1. Prerequisites for practical test: Title 14 of the Code of Federal Regulations (14 CFR) part 61, § 61.39(a)(6)(i) and (ii).

I certify that (First name, MI, Last name) has received and logged training time within 2 calendar-months preceding the month of application in preparation for the practical test and he/she is prepared for the required practical test for the issuance of (applicable) certificate.

/s/ [date] J. J. Jones 987654321CFI Exp. 12-31-19

2. Review of deficiencies identified on airman knowledge test: § 61.39(a)(6)(iii) as required.

I certify that (First name, MI, Last name) has demonstrated satisfactory knowledge of the subject areas in which he/she was deficient on the (applicable) airman knowledge test.

/s/ [date] J. J. Jones 987654321CFI Exp. 12-31-19

STUDENT PILOT ENDORSEMENTS

3. Presolo aeronautical knowledge: § 61.87(b).

I certify that (First name, MI, Last name) has satisfactorily completed the presolo knowledge exam of § 61.87(b) for the (make and model aircraft).

/s/ [date] J. J. Jones 987654321CFI Exp. 12-31-19

4. Presolo flight training: § 61.87(c).

I certify that (First name, MI, Last name) has received the required presolo training in a (make and model aircraft). I have determined he/she has demonstrated the proficiency of § 61.87(d) and is proficient to make solo flights in that make and model aircraft.

/s/ [date] J. J. Jones 987654321CFI Exp. 12-31-19

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5. Presolo flight training at night: § 61.87(c) and 61.87(o).

I certify that (First name, MI, Last name) has received the required presolo training in a (make and model aircraft). I have determined he/she has demonstrated the proficiency of § 61.87(o) and is proficient to make solo flights at night in that make and model aircraft.

/s/ [date] J. J. Jones 987654321CFI Exp. 12-31-19

6. Solo flight (first 90-day period): § 61.87(n).

I certify that (First name, MI, Last name) has received the required training to qualify for solo flying. I have determined he/she meets the applicable requirements of § 61.87(n) and is proficient to make solo flights in (make and model).

/s/ [date] J. J. Jones 987654321CFI Exp. 12-31-19

7. Solo flight (each additional 90-day period): § 61.87(p).

I certify that (First name, MI, Last name) has received the required training to qualify for solo flying. I have determined he/she meets the applicable requirements of § 61.87(p) and is proficient to make solo flights in (make and model).

/s/ [date] J. J. Jones 987654321CFI Exp. 12-31-19

8. Solo takeoffs and landings at another airport within 25 nautical miles (NM):

§ 61.93(b)(1).

I certify that (First name, MI, Last name) has received the required training of § 61.93(b)(1).

I have determined that he/she is proficient to practice solo takeoffs and landings at (airport name). The takeoffs and landings at (airport name) are subject to the following conditions:

(List any applicable conditions or limitations.)

/s/ [date] J. J. Jones 987654321CFI Exp. 12-31-19

9. Solo cross-country flight: § 61.93(c)(1) and 61.93(c)(2).

I certify that (First name, MI, Last name) has received the required solo cross-country training.

I find he/she has met the applicable requirements of § 61.93, and is proficient to make solo cross-country flights in a (make and model aircraft), (aircraft category).

/s/ [date] J. J. Jones 987654321CFI Exp. 12-31-19

10. Solo cross-country flight: § 61.93(c)(3).

I have reviewed the cross-country planning of (First name, MI, Last name). I find the planning and preparation to be correct to make the solo flight from (origination airport) to (origination airport) via (route of flight) with landings at (name the airports) in a (make and model aircraft) on (date). (List any applicable conditions or limitations.)

/s/ [date] J. J. Jones 987654321CFI Exp. 12-31-19