UAS Request Form

If you see this don't fill out this input box.

Applicant

Name*

Email*

Phone*

Affiliation*

K-State student

K-State staff

K-State faculty

Other

Other affiliation

Is the weight of the aircraft less than 55 pounds?*

Yes

What authorization type will the flight be conducted under?*

Location

Latitude

Longitude

Radius

Map upload (if Lat/Long/Radius is not specific enough)

Start date*

End date*

Time of day/night the flight(s) will be conducted*

Daylight

Civil twilight

Night

Special equipment onboard the UAS required by the FAA for the operation

Please provide a brief description of your operation. If there are circumstance that my contradict FAA regulations or K-State policy, please provide a safety explanation and supporting documents.*

If applicable, please provide additional documentation that would support your operational safety explanation. e.g. FAA wavier or authorization.

*Insurance certificate or justification for not needing to meet the policy requirement.

Additional information

UAS information

UAS 1 make*

UAS 1 model*

UAS 1 registration number*

UAS 1 payload/cargo

UAS 2 make

UAS 2 model

UAS 2 registration number

UAS 2 payload/cargo

UAS 3 make

UAS 3 model

UAS 3 registration number

UAS 3 payload/cargo

If more than three UAS, attach as a Word document

Additional information

If Applicable

Department

Title

Remote Pilot in Command Certificate number(s)

RPIC 1 name

RPIC 1 number

RPIC 1 date of issuance

RPIC 2 name

RPIC 2 number

RPIC 2 date of issuance

RPIC 3 name

RPIC 3 number

RPIC 3 date of issuance

If more than three RPICs, attach as a word document

Upload FAA TRUST certificate if operating as a recreational flyer

Hold Harmless Agreement

Terms and conditions*

I agree to the terms and conditions stated below.

I have read and will comply with the Kansas State University Unmanned Aircraft Systems Policy.
If taking photography or video, I will comply with Guidelines for Photo and Video on the Kansas State University Campus.
I will comply will all applicable local, state, and federal regulations while flying the UAS.
I certify that the information entered the Kansas State University Unmanned Aircraft Systems Request Form is complete and accurate.
I certify that I will notify the Kansas State University Division of Facilities if there are any changes or alterations to my request while it is active.