/ European Aviation Safety Agency / Form
Application for
Air Traffic Controller (ATCO) Training Organisation Approval

1  Applicant

Data protection: Personal data included in the application related to the “ATCO Training Organisation Approval” 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

1.1.2 Applicant Name

(Company Name or Legal Person name)

1.1.3 Applicant Address(registered business address/address of registry)

/ Street / Nr
Post Code
City
Country

1.1.4 Contact Person (responsible for this application)

/ Title / Mr Ms
Name
First name
Job title
Phone/Fax
Email
1.2 Principal Location / Same as Applicant Data in section 1.1 (→continue with section 1.3)

1.2.1 Applicant Name

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

1.2.2 Principal Location Address

/ Same as in section 1.1.3 Address / Other (please specify below)
Street / Nr
Post Code
City
Country
1.3 Additional Locations / Yes / No

1.3.1 Applicant Name

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

1.3.2 Location Address

/ Street / Nr
Post Code
City
Country

Please duplicate this table to add further locations.

1.4 Billing Data / Same as Applicant Data in section 1.1 (→continue with section 1.4.4)

1.4.1 (Company) Name

/ Same as in section 1.1.2 Applicant Name (other name only in exceptional cases)

1.4.2 Billing Address

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

1.4.3 Contact Person (Financial)

/ Same as in section 1.1.4 Contact Person / Other (please specify below)
Title / Mr Ms
Name
First name
Job title
Phone/Fax
1.4.4 Financial Contact Email
Invoice PDF copy will be issued to this address
1.5 Approval Delivery Data / Same as Applicant Data in section 1.1

1.5.1 Applicant Name

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

1.5.2 Delivery Address

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

1.5.3 Contact Person

(Approval Delivery) / Same as in section 1.1.4 Contact Person / Other (please specify below)
Title / Mr Ms
Name
First name
Job title
Phone/Fax
Email

2. Applicant’s Reference (Please provide an individual reference to this application)

Your reference /

3. Identification of Activity

3.1 Activity

/

3.1.1 Application for initial Approval

3.1.2 Application for change to Approval

3.2 Original Approval Ref.please complete in case of 3.1.2

/

3.3 Issued byplease complete in case of 3.1.2

/
4. Type of Training
for which Certification is requested in accordance with the provision of Regulation (EU) 805/2011
4.1 ATCO Initial Training
Type of Service / Part of Service / Sub-part of Service
Basic Training / N/A / N/A
Rating Training / Aerodrome Control Visual (ADV) / N/A
Aerodrome Control Instrument (ADI) / Tower Control (TWR)
Ground Movement Control (GMC)
Ground Movement Surveillance (GMS)
Air Control (AIR)
Aerodrome Radar Control (RAD)
Aerodrome Control Procedural (APP) / N/A
Approach Control Surveillance (APS) / Radar (RAD)
Precision Approach Radar (PAR)
Surveillance Radar Approach (SRA)
Automatic Dependent Surveillance (ADS)
Terminal Control (TCL)
Area Control Procedural (ACP) / N/A
Area Control Surveillance (ACS) / Radar (RAD)
Automatic Dependent Surveillance (ADS)
Terminal Control (TCL)
Oceanic Control (OCN)
4.1.1 Special Limitations / Conditions
4.2 ATCO Unit Training
Type of Service / Transitional Training
On-the-job Training
4.2.1 Special Limitations / Conditions
4.3 ATCO Continuation Training
4.3.1 Special Limitations / Conditions
4.4 OJTI Training
4.4.1 Special Limitations / Conditions
4.5 Training for Examiners and/or Assessors
Type of Service / Training for Examiners
Training for Assessors
4.5.1 Special Limitations / Conditions

5. Description of changes applied for under existing Approval Certificate

5.1 Changes to the Organisation

/

[description]

5.2 Changes to the Services

/

[description]

6. Other

6.1. Number of staff involved in the activities under the Type of Training

/

6.2 List of documentation to be provided with the application

a)  Organisation Exposition including company flow-charts and, as relevant, description and information on ATCO TO activities and organisation of partners or subcontractors
b)  Initial Training Plan / Unit Training Plan / Unit Competence Scheme, as applicable
c)  A copy of the national Companies register / Certificate of Incorporation

7. Quote Request

I hereby request EASA to provide a quote for the estimated total charges related to this application.
EASA is to continue the processing of this application only after the quote has been accepted.
I am aware that the provision of a quote will lead to a delayed project start.

8. Applicant’s declaration and acceptance of the General Conditions and Terms of Payment

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 or changes will be levied by EASA in accordance with the Commission Regulation (EC) No. 593/2007 of 31 May 2007 on the fees and charges levied by the European Aviation Safety Agency, as last amended and available from http://easa.europa.eu/> Legislation > Fees & Charges.
I acknowledge that I have read and understood the Agency’s Terms of Payment (see http://easa.europa.eu/> Legislation > Fees & Charges>General Conditions and Terms of Payment) and agree to abide by them. I declare to be aware that fees or charges, as well all relevant travel costs must be paid whether or not the application is successful and that they might not be refundable. Moreover, I declare that I am aware of the consequences of non-payment.
Date/Place / Name of Accountable Manager / Signature
This Application should be sent by fax, e-mail or regular mail to:
European Aviation Safety Agency
Applications and Procurement Services Department
Postfach 10 12 53
D-50452 Köln
Germany
Fax: +49 – (0)221 - 89990 ext. 4461
E-mail:
Important Note: EASA cannot accept applications without signature. Please make sure that you sign the application.

Completion Instructions for FO.AOA.00006-001

This Application Completion Instruction Sheet will provide you with any additional instructions and requirements necessary to complete the Application for ATCO Training Organisation Approval Certificate. It is strongly recommended to use the English language. 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 / The name and contact details specified in this section are those of the person responsible for the application.
1.2.1 / The (company) name of the principal location. The name and address detailed specified in this section will be printed onto the EASA certificate.
1.2.2 / The address of the principal location specified.
1.3.1 / The name of any additional location. In case of several locations, you may duplicate table to add further locations.
1.3.2 / The address of any additional location. In case of several locations, you may duplicate table to add further locations.
1.4.1 / The (company) name specified in this section will be printed on the invoice/s EASA will issue.
1.4.2 / The address specified in this section will be printed on the invoice/s EASA will issue.
1.4.3 / The name and contact details specified in this section are those of the person that will be contacted for all issue connected with the EASA invoices. (e.g. accounts payable clerk)
1.5.1 / The (company) name specified in this section is where EASA will send the original approval.
1.5.2 / The address specified in this section is where EASA will send the original approval.
1.5.3 / The contact person of this section is the person the approval will be sent to.
Chapter 2: Applicant’s Reference
Your Reference: Please provide an individual internal reference to this application which you will want to see on all communication with EASA.
Chapter 3: Identification of Activity
3.1
3.2
3.3 / Tick the appropriate box to indicate whether this is an application for initial approval or change to existing approval
Indicate the reference of the existing Approval Certificate (e.g. EASA approval number)
Indicate the competent authority that issued the existing approval
Chapter 4: Type of Training
4.1 - 4.5 / a)  Tick the types of Training and Services as they appear to describe the scope of services for which certification can be requested/granted
b)  The “special limitations and conditions” proposed by the applicant should include all those conditions and limitations identified by the organisation in relation to the training for which certification is requested. The conditions proposed should be clearly formulated and fall under the categories of possible conditions to be attached to certificates in accordance with Regulation (EC) 805/2011
c)  Wherever necessary, the conditions can be described by means of references to documents attached to this application form or other relevant documentation.
Chapter 5: Description of changes applied for under existing Approval
5.1 -5.2 / Please provide a short summary of the changes applied for (ref. Chapter 3.1)
Chapter 6: Other
6.1
6.2 / The information to be entered here must reflect the number of staff, or in case of an initial approval the intended number of staff, for the complete activities to be covered by the approval and therefore must include also any associated administrative staff. Staff not working full time should be counted, with appropriate ratio.
Please provide the requested documentation together with this application form
FO.AOA.00006-001 © European Aviation Safety Agency. All rights reserved.
Proprietary document. Copies are not controlled. Confirm revision status through the EASA-Internet/Intranet. / Page 6 of 7