Va Form 22-6553c - Monthly Certification Of Flight Training
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2OMB Approved No. 2900-0162
Respondent Burden: 30 minutes
MONTHLY CERTIFICATION OF FLIGHT TRAINING
IMPORTANT: Read Important Notice, Privacy Act Notice and Instructions on reverse before completing this form.
1. FIRST-MIDDLE-LAST NAME OF STUDENT
2. FILE NUMBER
3. REPORTING PERIOD
A. BEGINNING DATE
B. ENDING DATE
(Complete only if this is a change from your address of record)
5. IF TRAINING WAS COMPLETED OR TERMINATED DURING
4. ADDRESS OF STUDENT
(State reason in Item 12)
REPORTING PERIOD, GIVE DATE
6. NAME OF CURRENT COURSE
7. FLIGHT INSTRUCTION FURNISHED FOR CURRENT COURSE DURING REPORTING PERIOD
A. TYPE OF INSTRUCTION
B. HORSE POWER
C. HOURS
D. RATE
E. AMOUNT
$
$
8A. COST TO STUDENT FOR INSTRUCTION DURING THIS REPORTING PERIOD
$
(If applicable)
8B. STATE AND LOCAL SALES TAXES
$
(If applicable)
8C. TOTAL COST TO STUDENT THIS REPORTING PERIOD TAXES
$
9. TOTAL COST TO STUDENT FOR THIS COURSE THROUGH END OF REPORTING PERIOD
$
10. SUMMARY OF TOTAL HOURS IN COURSE THROUGH END OF REPORTING PERIOD
HOURS GIVEN
MAXIMUM
HOURS GIVEN
TYPE OF INSTRUCTION
MAXIMUM APPROVED
TYPE OF INSTRUCTION
TO DATE
APPROVED
TO DATE
A. DUAL
D. GROUND
B. SOLO
E. OTHER
C. PRE-FLIGHT
AND
POST FLIGHT
11A. CLASS OF MEDICAL CERTIFICATE HELD BY STUDENT ON DATE THIS FLIGHT COURSE BEGAN
11B. DATE OF LAST EXAMINATION
(Indicate any substitution, flight test or variance from approval course)
12. REMARKS
CERTIFICATION: WE CERTIFY THAT the above entries are true and correct.
13A. SIGNATURE OF STUDENT
13B. DATE SIGNED
14A. SIGNATURE OF SCHOOL CERTIFYING OFFICIAL
14B. DATE SIGNED
(Include facility code)
16. VA OFFICE HAVING STUDENT'S RECORDS
15. NAME AND ADDRESS OF FLIGHT SCHOOL
22-6553c
VA FORM
EXISTING STOCKS OF VA FORM 22-6553c, JUL 2007,
MAY 2011
WILL NOT BE USED.
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