| Applicant Name | If this application is for a new license, please enter the firm or corporation name who will be holding the license. If this is a modification to an existing license, the applicant's name is not modifiable by the applicant. A change to the applicant's name must be requested in writing and sent via mail to the Experimental Licensing Branch. (refer to the address at the bottom of this document). |
| Applicant Address | If this application is a modification to an existing license, the address information is pre-filled from the current license. Applicants may update this information as required. At a minimum, applicant's must enter the attention line, address line, city and state. If applicable, please include the contact person's e-mail address. |
| Application Purpose | New License or Modification of License Please indicate if this is a new license or if this is a modification of an existing license. If it's a modification to an existing license, please specify the call sign associated with the license. The application will then be pre-filled with information from the current license. If this is a new license, and you wish to start fresh with a blank application, choose the "All New Data" option. If you wish to extend an STA into a regular experimental license, or for filing for a new regular experimental license that is similar to an existing filing in the database, choose the "uses information from an existing application (i.e. - a template)" option. Applicants should NOT use the template choice for modification of an existing license. Applicants should also remember to review the template information carefully and make any changes necessary to accurately reflect their current filing. |
| Existing License Information | If this is a modification to an existing license, this section is pre-filled with the file number of the application that resulted in the current license to be granted. In addition, the callsign of current license is also pre-filled. If it's a new license being requested, this area is left blank. This section is not modifyable by the applicant. |
| Government Contract Question | If you answer "YES" to this question, please submit a narrative statement giving the information stated by the question. Exhibits may be entered immediately after submitting this form or later by selecting the "Add Attachments" option from this web site's menu. NOTE: When submitting this exhibit, please enter "QUESTION 4: STATEMENT REGARDING GOVENMENT CONTRACT" in the description field and select the type of document as "Text Documents". |
| Use by Foreign Government Question | If you answer "YES" to this question, please provide the contract number and the name of the foriegn government concerned. Exhibits may be entered immediately after submitting this form or later by selecting the "Add Attachments" option from this web site's menu. NOTE: When submitting this exhibit, please enter "QUESTION 5: STATEMENT OF FOREIGN GOVERNMENT USE" in the description field and select the type of document as "Text Documents". |
| Research Project Question | If you answer "YES" to this question, please provide the information stated by the question. Exhibits may be entered immediately after submitting this form or later by selecting the "Add Attachments" option from this web site's menu. NOTE: When submitting this exhibit, please enter "QUESTION 6: STATEMENT OF RESEARCH PROJECT" in the description field and select the type of document as "Text Documents". |
| If Questions 4,5 and 6 Don't Apply | If all the answers to questions Please provide the information stated by the question. Exhibits may be entered immediately after submitting this form or later by selecting the "Add Attachments" option from this web site's menu. NOTE: When submitting this exhibit, please enter "QUESTION 7: PURPOSE OF EXPERIMENT" in the description field and select the type of document as "Text Documents". |
| Government Contract Question Details | If you answer "YES" to Government Contract Question you are required to provide one or more names of the contracting agencies for which the license will be for, contracts that you are operating on, and point of contract name and number that can be used to verify if necessary. All fields are required to be filled in. |
| Use by Foreign Government Question Details | If you answer "YES" to Use by Foreign Government Question you are can provide one or more names of the foreign government for which the use of this license will be for, any associated contract numbers, and a government point of contact name and number. These fields are all optional. |
| Estimated Experiment Duration | Please enter an estimate of time that will be required to complete the program of experimentation proposed in this application. In addition, please state whether the estimate is in years or months by selected the proper value in the drop-down list next to the field. |
| Environmental Impact Question | If you answer "YES" to this question, please provide the information stated by the question. Exhibits may be entered immediately after submitting this form or later by selecting the "Add Attachments" option from this web site's menu. NOTE: When submitting this exhibit, please enter "QUESTION 9: STATEMENT OF ENVIRONMENTAL IMPACT" in the description field and select the type of document as "Text Documents". |
| Transmitting Equipment | Please indicate all transmitting equipment that will be used in this experiment. At least one line of transmitting equipment must be entered before the application will be accepted. For each row of transmitting equipment, the manufacturer, number of units and whether it is for experimental use columns are required. |
| Station Identification Question | Please refer to Section 5.115 of the FCC Rules before answering this question. |
| Applicant Clasification | Please indicate the class that best describes the applicant. If "OTHER" is specified, please submit an exhibit that describes the type of applicant. Exhibits may be entered immediately after submitting this form or later by selecting the "Add Attachments" option from this web site's menu. NOTE: When submitting this exhibit, please enter "QUESTION 12: STATEMENT OF APPLICANT CLASSIFICATION" in the description field and select the type of document as "Text Documents". |
| Foreign Government Question | Foreign governments may not apply for a new or modification of license. |
| Previously Denied or Revoked Question | If you answer "YES" to this question, please submit an exhibit stating the information listed by the question.Exhibits may be entered immediately after submitting this form or later by selecting the "Add Attachments" option from this web site's menu. NOTE: When submitting this exhibit, please enter "QUESTION 14: STATEMENT OF PREVIOUS LICENSE DENIAL/REMOVAL" in the description field and select the type of document as "Text Documents". |
| Contact Information | Please indicate the person who can best handle inquiries by the FCC. If applicable, please include the contact person's e-mail address. |
| Drug Abuse Certification | By answering "YES" to this question, you are stating you comply with the rules stated in this question. Applications will not be accepted if the applicant answers "NO" to this question. |
| New License or Modification of License | Please indicate if this is a new license or if this is a modification of an existing license. If it's a modification to an existing license, please specify the callsign associated with the license. The application will then be pre-filled with information from the current license. |
| FCC MAILING ADDRESSES: |
Federal Communications Commission Office of Engineering and Technology Experimental Licensing Branch 45 L Street NE Washington, DC 20554 |