iHFORMAT IOH S HEET rhi .,~.~.,stionnaire ho~ beon pr oparod ao that you ~an g ive the U. S. A ir Fore:~ os mu~h :ntcf:'l'~l en o5 pos-s !blo c oncerning tho unide ntified aerial phenomenon that yo u hovo ob~&rved. Plaot'l~ tr~ 1o orw-Hor o s many questions aa you pouibly can. The information that you gi vet will :~so-orch purpo~e, and will bo r~gardod aa c:onfidontiaf material. Your name will not h0 w~:d !n connecr ion with c~y statements, r.onc:lualona, or publlc:otions without your pttrmiulcn. We r~c;ve:st this p.4r5~no! information 10 tha t, If It Ia d~emed noc:e1sary, we may contact you for furv r .J~tJils Tim~ of day: Hour Mlr~Uhl$ (Ci rcle One): (Ci c:l~ On8): o , Daylight Saving b. S~ondard Stot~ or Country ! ~c ~ <:eroin you ore oi your on~wer ~o Questio n 5. :. No? very sure d. Juat o g uess ~h> ('ble C I d. Just a t:-nco of doyl ight e. No trace of dayl ight f. Don' t rem.em ber ~ur 11~} YL!GHT, TWILIGHT, or DAWN, wh..,re W05 the SUr./ locCJte d a s you lo oktd a " d. T u your I eft 0 v e dHw d Oon' t rcmemlt~r 8. IF V OIJ r.r:u-r the oojoct. c ' 1 ~lGHT, TWILIGHT, o~ DAWN, what did you noticCJ con~:..:rning tho ST i\RS a nd MOON? B.2 MOON (C ird! )n"): a. Bright :-nooillivht b. Dull 'ltoo nli{Jht No mo"n I i~ht -pltc.h d ark d. Don't re member d. Don't rttm&!l'bo'tr 9, Was th ~!~-:; !:righter ~har. rhe background of the! &k)? a. Ye!J t>. No o n r , "'mern er 10, IF it was BRIGHTER THAN the sky badcgrou11d, W(U the brlohtnes!S like that of on IJUtome>hlfl!t l1eodllght?: ( Circle Ono) a, A mile or more away (a dlstcnt ~ar}'f b . Sevoral blocks away? e. A block away? d . Several yards away? e , Oth.,r Did ! O)l::Ct: a. App~or to stand : r:ll ot any t ime? b. SLJdcr,l y speed up and rv sh away ot ony t.,e" c . ~r:~ up in~o "cr' c o: e xplode? ~-r~ ... ..,:g brightness? (Cirele OntJ fot \!ach question) No Don't Know No Don't Know No Don't Know No Don't Know Don't Know Don' t Know , "crtculorly c :; Oon' !<now. !F voJ on:swert-d YES, rhort hlfi -Nhot Don'r i<noH, IF you arn.wnrad YES: thon t"JII hot- 14. Did t he ob!ec c;>c9or: ' C irc ~One): a. Soi !d? b. Tran:~poren? c. Don'~ now. I 15. Did you o b se:ve ."'~? objo~t a. ~vee -:ss::s Binocular~ Thao<.!ol it8 Orow ~ plet\lrO that will tho,.,. ~ho r.thap~ of th!'l oblect or objett . Lobel and Jneludo ' " your ak~tclt any details ,h., obt -=~ thnt you "'"'-" !H1c h o!.l wlng11, prntrualont, catc., and cup.cloJiy ~!!<hou-'' 9r~llu or vopor 'rallt. Plac ", cr""w :>.;lllc' th~ drawl.1Q ?.:> nhow th~ dir<J~:Uon th obfec:t wet moving. .rr ohln~(; 25. Who re were you locnted when yo u sow the object? fCircle One): 26. Were you (Circle One) ins ide o bu tid j,,g In a car o. c. Outdo on In an airplane In the business section of a city? In the residential section of o city? In open countryside? Flying near on airfield? Flying over a city? Flying ov tr open country? What were y9u d oing at the time ~ou sow the object, and how did you happen to notice it? 28. IF yo.: were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the following questions: 28.1 What direction were you moving? (Circle One) o. North c. East b. Northeast d. Southeast f. Southwest h. Northwest 28.2 How fest' were you ~Mving? -----------miles per hour. 28.3 Did you stop at a ny time while you were looking ot the object? (Circle One) Yes No 29. Whor cr~ct:on were )'OU looking when you first sew the object? (C~rcle One) South g. West w Southeast f. Sout;:west h. Northwest o. a . Wna~ c ; !'':' on w~re yo"J oo<,,; wren you last sew the object? (Circle One) North East South West b. Northeast d. Southeast f. Southwest h. 31. If you ere i~mi I iar w ith be.:: -~ te s : ongulor d irec:tion), try to estimaTe the number of degrees the object was from rn.;e NJrh ond also :~ 1umbe cf degrees it was upward from the horizon (elevation). W-1er. i ; 1rst ap;:>eoreo: C!. r::rOIT'I tru e N':lrth ------degrees. ~-From h:mzon degrees. 31.2 "'"en : ~ scppeared. a . F ror. true Norrr, ------degrees. -,m nor1:on -----egrees. 34. What were the weather conditions at the time you saw the abjsct? 34.1 CLOUDS (Circle One) 34.2 WIND (Circle One) a. Clear sky b. Slight breeze c. Scattered clouds c. Strong wind d. Thick or heavy clouds Don't remember Don't remember e . 34.3 WEATHER (Circ:le One) 34.4 TEMPERATURE (Circle One) b. Fog, m"st, or light rain c. ModProte or heovy rain e. Don't remember 35. When did you report to some offic ia I that you had seen the objoct? 36. Was anyone else with you at the time you saw the object? (C irele One) 36.1 IF you answered YES, did they see the object too? ( CircleOne) Yes No 36.2 =>!ease l ist their names and addresses; Don't remember 37. Wos ~his the first time tho~ you had see;, an obj.,et or objects likG this? j ( Circle One) Y~s No l 37, 1 IF you a.nswered NO, r:1e n when, where, and under what circumstances did you s0e other ones? 38. In yC'vr opinion whet d~ you tL,ink the object was and what might have caused it? 39. Do you think you can estimate the speec/ of the object? (Circle One) IF you answered YES, then what speed would you estimate? 40. Do you think you can estimate how far away from you the object was? (Circle One) IF you answered YES, then how far away would you say it was? 41. Please g ive the flowing information about yourself: Firat Nome Mlcldle Name Street City TELEPHONE NUMBER _ Pleose ;~dlccte any special educational troining that you have hod . a. Grod e school e. e. Technical sehool High school (Type) . c. Ccllege f. Other special training d. P o s t graduate 42. Date yow completed this q uesn onnoire: Month Year