1. OA TE TIM! GltOUit S. LINOTH 011 OIIIRVATION 7. COUIIS! 9. PHYSICAL I!VID!MCI 2. LOCATION 10. CONCLUSION 11. 1111111 IUMMA.Y AND ANALYSIS This questionnaire has been prepared to that you can give the U. S. Air Force as much information at potsible concerning the unidentified aerial phenomenon that you have observed. Please try to answer as many questions as you possibly can. The information that you give will be used for rvsearch purposes, and will bo regarded as confidential material. Your name will not be used In connection with any statement., conclusions, or publications without your permisaion. We request this personal information so that, if it is deemed necessary, wo may contact you for 1. When did you see the object? Month Yeor J . Time zone: (Circle One}: c){ Eastern b. Central c. Mountain d. Pacific 2. Tin1e of day: (Circle One): (Circle One): a. Daylight Saving li. Standard 4. Where were you when you saw the object? Eln r;t l'eJJt Neoreat Poatol Address Additional remarks: City or Town Stote or Country S. Estimate how long you sow the object. 5.1 Circle one of tho following to indicate how certain you are of your answer to Question 5. ~. C.ertQjn b. Fairly c~tain 6. What was the conditicn of the sky? (Circle One): a. Bright daylight b. Dull daylight ~. Brisf!t twil!~ c. Not very sure d. Just a gueu d. Just a trace of day I ight e. No trace of day I i ght Don't remember 7. IF you saw the object during DAYLIGHT, TWILIGHT, or DAWN, where was the SUN located as you lookad at the object? (Circle One): a. In front of you To your left b. In back of you e. Overhead c. To your right f. Don't remember IF you saw the obiect at NIGHT, TWILIGHT, or DAWN, what did you notice concerning the'STARSand MOON? STARS (C lrcle One): MOON (C lrcle One}: None a. Bright moonlight 1. A few b. Dull moonlight No moonlight -pitch dark Don't rememlter d. Don't remember Was the object brighter than the background of the sky? ( C lrele One): a. Yes it. No ~c. Don't remember IF It was BRIGHTER THAN the sky background, was the brightness like that of an automobile headlight?: (Circle One) A mile or more away (a distant car)? 1. Severo I b loclcs away? A bloclc away? Several yards away? Old the obiect: (Circle One lor each question) Appear to stand still at any time? Yes Don't Know Suddenly speed up and rush away at any time? Yes Don't Know Brealc up Into parts or explt~de? Yes 0 Don't Know d. Give off s molce? Don't Know Change brightness? Yes Don't Know f. Chong shape? ~ Don't Know g. Flicker, throb, or pulsate? Yes Don't Know Old the obiect move behind something at anytime, particularly a cloud? ( C irele One): Yes No Don't Know. IF you answered YES, then tell what it moved behind: Old the obiect move in front of something at anytime, particularly a cloud? (Circle One}: Don't Know. IF you answered YES, than tell what moved in front of: _ Did the ob iect appear: (Circle One}: a. Solid? b. Transparent? c. Don't Know. Did you observe the obiect through any of the following? Eyeglasses b. Sun glaues Windshield Window glau Binoculars f. Telescope Yes No Theodolite 16. Tell Itt a few words the following things about the object. 17. Draw a picture that will show the shape of the obfect or obiecta. Label and include In your sketch any details of the obfect that you aaw such as wings, protrusions, etc., and especially exhaust trails or vapor trolls. Place an arrow beside the drawing to show the direction the obfect was moving. The edges of the object were: (Circle One): a. Fuzzy or blurred b. Like a bright star c. Sharply outlined d. Don't remember IF there was MORE THAN ONE object, then how many were there? Tuo rer; bl:i,nr: s-;uc?rn Draw a picture of how they were arranged, and put an arrow to show the direction that they were traveling. Tra.vo1 ing a t slo .. t rnte or ;;:-~eed" rro~. Cryr;taJ ':>..ke~1:0::"rt~'; ,:].:tol'L. ut ~bout 20. Draw a picture thCJt will show the matlon that the oblect or oblct made. Place on A at .the beglnnlng of the path, a a at the end of the path, and show any changes In direction during the course. 21. rF POSSIBLE, try to guess or estimate what the real size of the oblect was In ita longest dimension. 22. How Iorge did the oblect obiects appear as compared with one of the following obiech heiJ in the hone/ and at about arm's length? (Circle One): a. Head of a pin Silver dollar h. Baseball Grapefruit Basketball Half dollar 22.1 (Circle One of the following to indicate how certain you ore of your answer to Question 22. a. Certain c. Not very sure b. Fairly certain d. Uncertain 23. How did the obiect objects disappear from vlew?P!lse;ed f1r>'"' vl elI t c ... ,rd:: 24. In orcler that you con tlvo clear a picture as poulltlo of what you saw, wo woulcl lilco for you to Imagine that you could construct tho oltjoct that you SIJW. Of what typo material woulcl you malce It? How Iorge would It be, and what shopo woulcl It hove? Oescrllto In your own words a common oltjoct or oltjocts which when plocod up In tho sky would give the some oppeoronco tho obioct which you saw. 25. WheN were 'you located when you saw the obiect? (Circle One): 26. Were you (Circlo One) a. Inside a building b. In a car c. Qutdoon cl. In an airplane a. In the business section of o city? b. In the residential section of a city? cl. Flying near an airfield? Flying over a city? f. Flying over open country? 27. What were you doing at the time you saw the object, and how did you happen to notice It? ?8. IF you wore MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the following questions: 28.1 What direction were you moving? (Circle One) a. North c. East e. South g. West b. Northeast cl. Southeast f. Southwest h. Northwest 28.2 How fast were you moving? Old you stop at any time while you were looking at the obiect? (Circle One) Yes No 29. Whot direction were you looking when you first saw the object? (Circle One) a. North c. East d. Southeast f. Southwest h. Northwest 30. What direction were you looking when you last saw the object? (Circle One) To,ar ~s J yto""l fro~ C:-,...*:1 .. 1 g. West A~ h. Northwest ,~ --(/ d. Southeast b. Northnst f. Southwest 31. If you oro familiar with bearing terms (angular direction), try to estimate the number of degrees the object wos from true North and also the number of degrees it was upward from the horizon (elevation). When it first appeared: a. From true North-----degrees. b. From horizon 31.2 When it disappeared: a. From true North-----degrees. b. From horizon degrees 34. What were e Wt. .ther condition.; at tho time you sow the obiect? CLOUDS (Circle Ono} 11 Clear sky c. Scatterod clouds d. Thick or heavy clouds Don't re member 34.3 WEATHER (Circle One} b. Fog, mist, or light rain c. Moderate or heavy rain e. Don't remember 34.2 WIND (Circle One) o. No wind b Slight breeze c. Strong wind d. Don't remember 34.~ TEMPERATURE (Circle One) Don't remember Whe n d id you report to some official that you hod seen the object? Wus anyone efse with you at tho time you saw the object? (Circle One) Yes 36.1 IF you answered YES, did the y soe the object too? (C lrcle One) Yes No 36.2 Please list their names and addresses: 37. Was this the first time that you hod seen on object or objects like this? (Circle One) Yes 37.1 IF you answered NO, then when, where, and under what circumstances did you see ather ones? 3 8. In your opinion what do you think the object was and what might have caused it? 39. Do pu thlnlc.you can estimate the speeJ of the object? (Circlo One) IP you answered YES, then what speed would you estimate? . .fO. Do you thlnlc you can estimate how far away from you the object was? ~-t e!"'tc..J ubjoct i" n 1 Cxy~;t".J. (Circle One) Yes No 3~000 rt n1 t. J ru:c. IF you answered YES, then how far away would you say It was? 41. Please give the following Information about yourself: Zone Stoto TELEPHONE NUMBER --------- Ptease Indicate any special educational training that you have had. a. Grade school e. e. Technical school High school Other special training Post graduate Date you completed this questionnaire: