Draft Form FTO

/ European Aviation Safety Agency / Form

Application for EASA Technical Training

1Applicant

Data protection: Personal data included in the application related to the “Application for EASA Technical Training” is processed by EASA pursuant to Regulation (EC) No 45/2001 on the protection of individuals with regard to the processing of personal data by the Community institutions and bodies and on the free movement of such data. It will be processed solely for the purposes of the performance, management and followup of the Application by the Agency, without prejudice to possible transmission to internal audit services, to the Court of Auditors, to the European Anti-Fraud Office (OLAF) for the purposes of safeguarding the financial interests of the European Union. The Applicant shall have the right of access to his personal data and the right to rectify any such data that is inaccurate or incomplete. Should the Applicant have any queries concerning the processing of his personal data, he shall address them to the Agency at the following address: . The Applicant shall have right of recourse at any time to the European Data Protection Supervisor.
1.1 Applicant Data

1.1.1 Customer Number

(if known)

1.1.2Organisation Name*

1.1.3 Address*(registered business address)

/ Street / Nr
PO Box
Postal code
City
Country

1.1.4 Organisation type*(please choose 1 option that best describesyour organisation)

/ National Aviation Authority or government organisation
University or other state-recognised educational institution
Industry Association
Private individual seeking training on a topic for which EASA is the only Competent Authority

1.1.5 Contact Person*(responsible for this application)

/ Title / Mr Ms
Name*
First name
Job title
Phone*/Fax
Email
1.2 Address at which training is to be delivered* / Same address as in section 1.1.3
EASA premises (Cologne, Germany)
Other venue (please specify below)
Venue name
Street / Nr
Postal code
City
Country
1.3 Billing Data / Same as Applicant Data in section 1.1 (→ continue with Chapter 2)

1.3.1 Applicant Name

/ Same as in section 1.1.2 Organisation Name / Other (please specify below)
Name

1.3.2 Billing Address

/ Same as in section 1.1.3 Address / Other (please specify below)
Street / Nr
PO Box
Postalcode
City
Country

1.3.3 Contact Person(Financial)

/ Same as in section 1.1.5 Contact Person / Other (please specify below)
Title / Mr Ms
Name
First name
Job title
Phone/Fax
1.3.4 Financial Contact Email*
PDF copy of invoice will be issued to this email address

2Technical Training Course / Workshop / Lecture

2.1 EASA Deliverables Requested* / Technical Training Course (ELG reference:)
Other:
Title
Code
(if known)
Duration
2.2EASA Contact Person or Trainer
(if known)
2.3 Requested Dates* / Date(s):
Alternative dates
(if applicable)
2.4 For training at applicant premises only(if not applicable, continue with section 2.5)
2.4.1 Name of applicant training programme
(if applicable) / Title
Qualification
2.4.2 Expected attendee profile / Role
Experience
Qualifications
2.4.3Expected outcome / objective of EASA training
2.4.4Advantage for EASA’s activities and objectives (optional)

2.5 For training at EASA premises only

Participant # / Participant Details
1 / Surname
First name
Email
2 / Surname
First name
Email
3 / Surname
First name
Email
N / Surname
First name
Email

insert additional rows as necessary

3Charges

3.1 EASA quote source*
(if known – please tick one option) / EASA Learning Gateway (ELG) / EASA Website
Formal orad hoc agreement or EASA Quotation, Letter, other correspondence
(to be attached)
3.2.1.Charges*
(if known – please tick one option) / agreed per quote: € per participant (w/o logistics)
agreed per quote: € per training (w/o logistics)
3.2.2.Logistics costs*
/ To be completely organised and supplied by the Applicant
To be completely organised by EASA and chargedto the Applicant
As addressed by formal agreement - to be chargedto the Applicant:
Accommodation
Ticket Costs
Subsistence costs (daily allowance)
Travel time
3.3Applicant’s Reference*
(please provide an individual reference to this application – this reference will be shown on the related invoice)

4Applicant’s declaration and acceptance of the Service Terms and Conditions for EASA Technical Training

I declare that I have the legal capacity to submit this application to EASA and that all information provided in this application form is correct and complete.
I have understood that I am submitting an application for which Fees & Chargeswill be levied by EASA in accordance with the Commission Regulation (EU) No. 319/2014of 27March 2014on the Fees & Chargeslevied by the European Aviation Safety Agency, its amendments and related ED decisions. Further information about the regulation on the fees and charges is available from
I acknowledge that I have read and understood the Agency’s Terms of Payment (see and agree to abide by them. I declare to be aware that fees or charges, as well as all relevant travel costs must be paid for example in case of late cancellation,and that they might not be refundable. Moreover, I declare that I am aware of the consequences of non-payment.
Furthermore, I understand that acceptance of this application remains entirely at the arbitrary discretion of EASA, and is subject to EASA’s internal priorities and the availability of its personnel and resources.
EASA training is limited to the staff and/or registered students/staff of the applicant organisation and their contractors.
EASA training is provided for information purposes only. All information provided is of a general nature only and is not intended to address the circumstances of any particular individual or entity. Any time there is a conflict or discrepancy between the information provided and information in an official regulation or agency document, the latter prevails.
All training materials, including any documentation, publications, software programs, and other information provided by or on behalf of EASA are furnished on an "as-is" basis, without warranty of any kind, whether express, implied, statutory or otherwise especially as to its quality, reliability, currency, accuracy or fitness for purpose.
Date/Place* / Name* / Signature*
This Application should be sent by fax, e-mail or regular mail to:
European Aviation Safety Agency
Technical Training
Postfach 10 12 53
D-50452 Köln
Germany
Fax: +49 – (0)221 - 89990 ext. 9521
E-mail:
/ European Aviation Safety Agency / Form

Application for EASA Technical Training

This Application Completion Instruction Sheet will provide you with any additional instructions and requirements necessary to complete the Application for EASA Technical Training. “Technical Training” shall mean to include trainings, workshops, seminars, lectures, etc.Fields marked with * are compulsory. Please complete the form in a clearly legible way.

Chapter 1: Applicant
1.1.1 / If known, please enter your EASA customer number. This number follows the pattern 3XXXXX and can be found on any application acceptance letter received for previous applications.
1.1.2 / Please enter the full name of the company as it appears on the Article/Certificate of incorporation of the company. If applicable also enter the Trade Name, Doing-business-as and the Company registration number. In case the applicant is not a company but a natural person, please enter the full name as it appears in your ID Card/Passport.
1.1.3 / Please enter the address of the registered office as it appears on the Article/Certificate of incorporation of the company. In case the applicant is not a company but natural person, please enter the address at which you are registered.
1.1.4 / Please choose the type of organisation that best fits your description.
1.1.5 / The name and contact details specified in this section are those of the person responsible for the application.
1.2. / The address specified in this section is where the Technical Training or Lecture will take place.
1.3 / Billing data: if Billing Address and Billing Contact Person are the same as provided in section 1.1 (and sub-sections), please tick the box in 1.3 and continue to Chapter 2. If different, please complete the rest of Chapter 1.
1.3.1 / See above.
1.3.2 / See above.
1.3.3 / See above.
1.3.4 / PDF copies of the invoice(s) will be sent to this email address.
Chapter 2: Technical Training Course
2.1 / Please provide details of the EASA Technical Training Course (or workshop, lecture, or similar) that is requested and applied for.
2.2 / Please indicate a contact person/trainer at EASA, if applicable
2.3 / Specify the preferred dates.
2.4.1 / In case the requested training is to be part of a training programme or curriculum within the Applicant’s Organisation, please provide details of that programme.
2.4.2 / Please describe the profile of expected attendees.
2.4.3 / Please describe the purpose, objective or expected outcome of the training.
2.4.4 / If possible, explain the existence of a mutual benefit of the training delivery.
2.5 / For training at EASA, please enter the details of the participants. Use as many rows (one row per participant) as necessary.
Chapter 3: Charges
3.1 / If known, please choose one of the frameworks applicable that covers the charges for this training.
3.2 / If you have already received an EASA quote for this training, please indicate the details thereof.
3.3 / Same as above, but with amount specified.
3.4 / Please indicate if arrangements and costs with regard to the travel itinerary and accommodation for the EASA Instructor(s) have already been agreed upon.
3.5 / Please provide your own reference for this application. This reference will then be used on the EASA invoice.
Chapter 4: Applicant’s declaration
n/a / Applicants are invited to carefully read these Terms and Conditions (if necessary by consulting EASA’s Website) and to sign with their agreement and understanding. Please note that only authorised persons should do so.
FO.TT.00132-002 © European Aviation Safety Agency. All rights reserved. / Page 1 / 6
Proprietary document. Printed copies are not controlled. Confirm revision status through the EASA-Internet/Intranet.