sUAS Approval Form

Is request for (please check one):

Commercial or Business Operation

Hobbyist

Research, Education or Service

Affiliation:

Current UCCS faculty or staff

Current UCCS student

Non-university

Name of organization or individual requesting approval:

Organization's or individual's address:

Telephone number:

Cell phone number:

Email Address:

Name of primary contact:

Note: Multiple dates of operation may be requested but shall not be for more than one academic semester

Requested date(s) and time(s) of sUAS operation on the campus:

sUAS type and model #:

FAA Registration sUAS #:

Weight of sUAS without payload:

Does the requestor possess a remote pilot's license:

Yes

Purpose of request:

Location(s) of proposed sUAS activity:

If photography, videography, or audio recording is involved in this request, additional reviews and approvals may be required prior to approval being provided. (please select an option):

Photography

Videography

Audio Recording

None

Other…

Explain how the use of sUAS meets the mission of UCCS:

Explain how the insurance requirements will be met (not required for University sponsored research, education, or service):

Will the sUAS be modified in any way from its original manufacturer's specifications? If so, please explain:

Required Permits:

Flight plan requirements (not required for hobbyist as long as airports within a 5 miles radius have been notified):

Safe Operation of sUAS:

By checking the box below I attest that I am knowledgeable and experienced in the flight and operation of the sUAS(s) listed above. I agree to abide by all university policies governing the use of sUAS on or over UCCS property or sponsored event. A copy of the approved sUAS Request Form must be in possession of the operator at all times during the activity, and must be presented to any university official or representative with control or jurisdiction over the activity, upon request. The university reserves the right to request additional documentation as a condition of this approval and operation. In addition, any UAS operator violating any portion of the UCCS UAS policy, will be held accountable for their actions. I affirm the statement.

Comments:

Photograph of sSUAS:

One file only.
100 MB limit.
Allowed types: gif, jpg, jpeg, png.

Small Unmanned Arial System (sUAS) “Commonly Referred to as Drones”