University of Michigan

Institutional Autonomous Systems Committee

Application for Use of

UNMANNED AIRCRAFT SYSTEMS (UAS)

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The purpose of the U-MInstitutional Autonomous Systems Committee (IASC) is to provide a path to approval so members of the University community can safely employ unmanned aircraft systems (UAS) for UM-sanctioned activities both on and off U-M properties.

This application must be completed to obtain permission to operate UASoutdoors from, on, or over the U-M Ann Arbor, Dearborn, or Flint campuses, and other U-M properties (e.g., Biological Station, Pellston, MI; Stinchfield Woods, Pinckney, MI; Camp Davis, Jackson, WY), for any purpose. The specific process for approval is outlined in the attached matrix.

This application must be completed by U-M faculty, students, and staffto obtain permissionto operate UAS off of U-M property for U-M sanctioned activities. For uses off U-M property,the committee will not consider an application until written permission from the Operating Site Property Owner and/or manager (OSPO) is obtained and submitted to the IASC. The IASC does not have authority with respect to off U-M propertyuses by those unaffiliated with U-M, or by U-M community members for personal uses or other uses unconnected with any U-M activities.

Indoor use of UAS is allowed on U-M property without application to the IASC or waiver of Article XV/permission of the Chancellor provided that:

a)the use will occur in a University space or building that has established policies and procedures to permit the safe operation of UAS,

b)the use is conducted in accordance with those policies and procedures, and

c)the building manager has granted permission for the use.

Please allow at least three weeksahead of your planned flight date for this entire process to be completed.

If you plan to fly at multiple locations, it is recommended to complete a separate application for each.

Notice - It is strongly recommended that applicants read and understand the following documents prior to completing this application:

  • Regents’ Ordinance Article XV
  • U-M Unmanned Aircraft Systems Outdoor Flight Operations Manual
  • FAA Small Unmanned Aircraft Rule (Part 107)
  • Section 333 Exemption No. 14410A issued to U-M, April 7, 2016
  • Blanket CoA for Small UAS Operations 400 feet and below
  • Section 336 of the FMRA as interpreted by the FAA, May 4, 2016

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Please complete the form below to apply for use of an unmanned aircraft system (hereafter, “UAS”) on or off U-M property. Email completed form to:

  1. Date of Application:
  1. Applicant
  2. Full Name of Applicant:
  3. Title and Affiliation (e.g., Professor of Aerospace Engineering, U-M; Student, LSA; Professor of Biology at MSU):
  4. Address:
  5. Phone Number(s) (include cell phone #):
  6. Email:
  1. General location of use (choose one). More detailed information will be asked at Q14.
  2. Outdoor from/on/over U-M Ann Arbor campus property
  3. Outdoor from/on/over U-M Dearborn campus property
  4. Outdoor from/on/over U-M Flint campus property

3.4.Outdoor from/on/over other U-M property, e.g., Biological Station, Stinchfield Woods, Camp Davis.Please specify: ______

Written permission from the property manager/representative of the above site is required for review of this application.

3.5.Off U-M property. Written permission from the property owner is required for review of this application.

  1. Owner of Unmanned Aircraft System (UAS)
  2. Name of UAS owner, if not the applicant:
  3. Contact information for owner, if different from above:
  4. Is the UAS owner a U-M faculty or staff member, or a student? Y/N
  5. If yes, indicate with which laboratory (by faculty name) or department, school/college (for UM courses) the UAS owner is associated.
  6. If no, please indicate the provider of the liability insurance that will cover the activitiesof each of the participants (e.g., PIC, VO):
  1. Detailsabout the UAS
  2. Is the UAS you plan to use commercially made/sold? Y/N
  3. If yes, indicate the exact make and model:
  4. Has this commercially made/sold UAS been customized in any way? Y/N
  5. If yes, please explain:
  6. If no (the UAS was not commercially made/sold), please answer “Custom” and provide an explanation:

5.2.What is the ‘N’ number that is on the aircraft?

5.3.Is the UAS or any other technology used in the proposed operation export-controlled? Y/N/Unsure

If yes, or unsure, please explain:

5.4.Please attach 2-3 photographs of the UAS.

5.5.Provide the weight of the UASwithout payload (in grams and in lbs):

5.6.Provide the weight of the UAS with payload (in grams and in lbs):

5.7.Is the propeller system ducted or otherwise shielded? Please explain.

5.8.What is the stored energy in the system at the time of launch? Please provide details:

  1. Type of Activity
  2. Describe the activity and its purpose (200-300 words):
  3. Is there a funding source for the activity (e.g., sponsored research project), or is there sponsorship or compensation provided of any kind? Y/N

If yes, please explain:

  1. Operational Protocols (based on FAA categories)

Under which of the following four operational protocols will the UAS be flown? Choose one:

7.1.14 CFR Part 107 (go to Question 8)

7.2.UM Section 333 Exemption (go to Question 9)

7.3.An external Section 333 Exemption (go to Question 10)

7.4.Section 336 (e.g.,as a “hobbyist”, for educational purposes, or as part of a team) (go to Question 11)

  1. Use of sUAS under 14 CFR Part 107
  2. Name of Remote Pilot in Command:
  3. Please attach a copy of theRemote Pilot in Command Certification:
  4. Describe the extent of the Remote Pilot in Command’s experience with the platform to be used, or similar platform, in similar operational scenarios:
  5. List all other individuals who will be directly involved in this operation, describe their roles/duties, and how they are qualified for this role/duty.
  1. Use of UAS under University of Michigan Section 333 (No. 14410A) Exemption Protocol
  2. Please attach a copy of your certificate of registration.
  3. Name of Pilot-in-Command (PIC), type of pilot license, and date of issue:
  4. Describe the extent of the PIC’s experience with the platform to be used, or similar platform, in similar operational scenarios:
  5. Name of Visual Observer (VO):
  6. Describe the extent of the VO’s experience with the platform to be used, or similar platform, in similar operational scenarios:
  7. How will the VO communicate with the PIC?
  8. List all other individuals who will be directly involved in this operation, describe their roles/duties, and how they are qualified for this role/duty.
  1. Use of UAS under another (external) Section 333 Exemption Protocol
  2. Please append a copy of the 333 Exemption
  3. Please attach a copy of your certificate of registration.
  4. Name of Pilot-in-Command (PIC), type of pilot license, and date of issue:
  5. Describe the extent of the PIC’s experience with the platform to be used, or similar platform, in similar operational scenarios:
  6. Name of Visual Observer (VO):
  7. Describe the extent of the VO’s experience with the platform to be used, or similar platform, in similar operational scenarios:
  8. How will the VO communicate with the PIC?
  9. List all other individuals who will be directly involved in this operation, describe their roles/duties, and how they are qualified for this role/duty.
  1. Use of UAS under Section 336 of the FMRA (i.e., educational, “hobbyist,” use of model aircraft)
  2. Indicate the responsible party by name (e.g., faculty member):
  3. Provide the FAA registration number that is displayed on the UAS:
  4. Is this activity in connection with a U-M course? Y/N
  5. If yes, list the course # and title:
  6. Is this activity in connection with a recognized student organization? Y/N
  7. If yes, specify organization and name of event (if applicable)
  8. List all individuals who will be directly involved in this operation, describe their roles/duties, and how they are qualified for this role/duty.
  1. Anticipated Dates of Operation
  2. Is this use intended to be (choose one):

One-time

Repeated - indicate how many times, and how frequently

12.2.Anticipated date(s) of operation:

12.3.Anticipated start time:

12.4.Anticipated end time:

  1. Location Permissions and Safety Considerations
  2. Location of intended use (indicate whether on or off U-M property, name of the property, and whether indoor or outdoor). If the intended use is off U-M property, indicate if you have obtained permission from the landowner or municipality. Provide name and contact information, and attach documentation of the permission granted. Note that the committee will not consider an application for use offU-M property by U-M faculty, staff, or students in connection with a UM-sanctioned activity until written permission from the Operating Site Property Owner and/or manager (OSPO) is obtained and submitted to the IASC.

13.1.1.Include the latitude and longitude (in decimal format) of the location.

13.1.2.What are the airspace classifications (e.g., A, B, C, D, E, G). Please append the appropriate sectional map (e.g., see and annotate the location of the proposed test area.

13.1.3.Include a screen shot of an aerial view showing the area where the flight will take place and annotate any features (e.g., fences, positions of PIC and VO) that will be employed during the operations.

13.1.4.What is the maximum altitude planned for this flight?

13.2.Has an independent Validation Flight been conducted? Y/N

If you have not yet had a validation flight, please contact the IASC at to inquire about the process, which can vary depending on the planned operation.

13.2.1.If yes, provide the date that it occurred and the name of the person who witnessed/validated the flight. Attach a copy of the report provided by the validator.

13.3.Explain how you will coordinate with local air traffic. Be specific regarding who you will contact and when. Include how you will fulfill the requirement for issuing a distant (D) Notice to Airmen (NOTAM) (see page 5 of the Blanket CoA).

13.4.Is this use in/over a populated area? Y/N

13.4.1.If yes, how will your activities be coordinated with other entities on the ground to ensure flights are safe for people and property on the ground?

13.5.Explain how you will secure the area to protect uninvolved bystanders.

13.6.Describe how the test range will be configured to ensure safety, e.g., how will you avoid flying toward or over people. If you will use tethers, explain this here including how many tethers, and who will be responsible for them during the flight. Clarify if the tether-operators will be different from the PIC and the VO.

13.7.Will ALL FLIGHTS be line-of-sight with direct operator override authority for a flight termination (kill) at any time such action is needed for safety and to maintain operations in the approved test range? Y/N*

*A response of ‘No’ here is unacceptable for approval. Note that the maximum radius for maintaining visual line-of-sight is not to exceed .5 miles, and certain weather conditions may require a smaller radius for visual line-of-sight.

  1. Explain how you will maintain a flight log:
  1. Notification Requirements, Pre-Flight
  2. Please confirm that you will take responsibility for any pre-flight notification requirements under FAA Part 107 if applicable to your flight, or listed in the FAA Section 333 Exemption document and in the CoA if applicable to your flight, and that you will take responsibility for all other pre-flight notifications that may be required by the IASC. Y/N
  1. Reporting Requirements, Post-Flight
  2. Please confirm that you will take responsibility for the post-flight reporting requirements under FAA Part 107 if applicable to your flight, or listed in the FAA Section 333 Exemption document and in the CoA if applicable to your flight, andthat you will take responsibility for all other post-flight reporting that is required by the IASC. Y/N
  1. U-M UAS Outdoor Flight Operations Manual
  2. Please confirm that you are familiar with and will take responsibility for compliance with the requirements of the U-M UAS Outdoor Flight Operations Manual. Y/N
  1. Please include any other information that may assist the committee in its review:

Signature Date

Email completed form to:

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IASC Application, Version 12, 5/24/17