Submitted by Anonymous (not verified) on Thu, 2016-11-10 10:44 Application to Operate UAS on Smith PropertySmith College is committed to promoting the use of new technologies in a safe and responsible manner. After you have submitted the form below, Margaret Rakas will contact you to confirm that you are approved to operate your UAS at the time and location requested. If you have any questions about the approval process, please reach out to Margaret Rakas during regular business hours at 413-585-3877, or by email at mrakas@smith.edu. Please note: This form is for individual requests. If you are a faculty or staff member who will be using UAS for a long-term project involving regular use, you may fill out a request for two-year authorization. Name * Affiliation with Smith College * - Select -FacultyStaffStudentVendorOther Visitor Department * Title * Company Name * Visitor Affiliation Details * Email * Phone * Smith Contact Name of Smith Contact * Email of Smith Contact * Details of Operation Supervising Faculty Member * Faculty Department Faculty Email * Faculty Phone Purpose * Research/Education Other College Business Registered Student Org Recreation/Personal Use Location * MacLeish Field Station Athletic Fields Main Campus Indoors Other... Location Other... Weight of UAS * Under 250 g (0.55 lb) 250 g - 4.5 kg (0.55 lb - 10 lb) 4.5 kg - 25 kg (10 lb - 55 lb) Scope of Operations * Estimated Altitude (AGL) * Please enter the highest estimated altitude at which you will need to operate your UAS above ground level. Note that operation of your UAS above the altitude entered here will be considered a breach of authorization. This estimate will factor into our evaluation of the risks associated with your operation request, but will not necessarily result in automatic rejection of your proposal. Crowd * Generally, UAS should not be operated near crowds such as sporting events, tours, concerts or graduation. I will not be operating near crowds. I will be operating near crowds. Operation Date Date * Year Year202420252026 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Start Time * Hour Hour123456789101112 : Minute Minute00153045 am pm End Time * Hour Hour123456789101112 : Minute Minute00153045 am pm Requirements FAA Authorization Number * Enter the seven (or eight) digit number associated with your Remote Pilot Certificate. To learn how this number can be obtained, visit the FAA website: www.faa.gov/uas FAA Authorization Number (Not Required) If you have a Remote Pilot Certificate, enter the associated seven (or eight) digit number. To learn how this number can be obtained, visit the FAA website: www.faa.gov/uas FAA License Expiration Date * Year Year202420252026 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 FAA License Expiration Date (Not Required) Year Year202420252026 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 If you entered an Authorization number above, enter its expiration date here. FAA UAS Registration Number * Please enter your UAS registration number. This can either begin with an FA followed by eight numbers, or an N followed by a combination of five letters and numbers. If you have not registered your UAS already, you may do so at the FAA website: https://registermyuas.faa.gov/ UAS Identification * While UAS weighing less than 250 grams may not require registration, the owner's name and contact information should be marked on the UAS in question. Check to make sure the UAS you are using is marked accordingly. If the UAS is your own personal device, be sure to mark it with your own details. I will make sure my UAS is appropriately marked. Proof of Liability Insurance * Proof of Liability Insurance must not be less than $1,000,000 for UAS operations. Please upload a pdf of your Proof of Liability Insurance. Files must be less than 2 MB.Allowed file types: pdf. Compliance with Procedure * Operators are expected to carry their authorization on their person while piloting a UAS. I will be sure to have my authorization materials on hand. Off-Campus Flights * Operators are responsible for obeying local air-traffic laws. We encourage you to research intended sites of operation in order to identify nearby no-fly-zones. You may be responsible for any fines incurred through failure to comply. I will obey local air-traffic laws and stay out of no-fly-zones.
