Ci vilic.."1 .t. NlJMB~R OF OBJECTS S. lENGTH CF OB,&AVATION TYPE OF OBSERVATION Ground-Visual Not Repc:-ted 8. PrlOTOS 9. Pt1Y SICAL E., :OENCE 10. CONCLUSION DlSUFFIC DATA FOR ~VALUATION U.S. AIR FORCE TECHNICAL INFORMATION T his questionnaire has been prepared so that you can give the U.S. Air Force as much information as possible 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 use:i for research purposes. Your name wi II not be used in connection with any statements, conc::h; s ions, or publications without your permission. We request this personal information so thot if i t is deemed necessary, we may contact you for further details. 1. When did y ou see the obiect? 3. Time Zone: 4. Where were c.~-Mounain d. Pac i f i : ou sow t he obje ct? (Circle One): (Circle One): a. Dayli_g~t Saving b. Stondarei \ Nearest Postal Address City or Town State or Ceunty S. How long -NCS object in sight? (Toto! Duration) Hours Minutes Seeonds c. Certain -- c. Not very sure ~ b . F:rirfy cert ;_.., d. Just a guess 5.2 Was :;,bje ::1 si~ht cont i nuously? Yes .~'--No ,....- 6. What was th~ ==r ion of the sky? 7. IF you saw the object during DAYLIGHT, where was the SUN located as you looke d at the object? (Circle One): a. In front of you b. In bade of you c. To your right d. To your left e. Overhead f. Don't remember FTD OCT 62 164 Thla lorm auperaedea Fm 164, jul 61, which Ia obsolete l UFO form continued 20. Do you think you can estimate the speed of the object? (Circle One) IF you answered YES, then what speed would you estimate? , ----- 21. Da you think you can estimate how far away from you the object was? (Circle One) G No : IF you answered YES, then how far away would you say it was? :l.,-J J1d-< '1=\L'{ .... ~e .. .)_ 22. Where were you located when you saw the object? (Circle One): 23. Were you (Circle One) a . In the business section of o city? Inside a building In the residential section of a city? In a car c. In open countryside? ~Outdoors d . Near an airfield? d. In an a irplane (type) e . Flying over a city? f. Flying over open country? e . At sea 24. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the following questions: 24.1 What direction were you moving? (Circle One) a. North c. East e . South b . Northeast d .-SouthPast f. Southwest 24.2 How fast were you moving? miles per hour. 24.3 Did you stop at any time while you were looking at the object? (Circle One) h. Northwest 25. Did you observe the object through any of the following? a . Eyeglasses b. Sun glaues c. Windshield ndow glass e . Binoculars f. Telescope g. Theodolite Yes No : 26. In order that you can give as clear a picture as possible of what you saw, describe in your own words a common object or ob jects which, when placed up in the sky, would give the same appearance as the object which vou saw. Official U.S. Air Foret 1 ~. Did the object disappear while you were watching It? If so, how? 15. Did the object move behind something at any time, particularly a cloud? (Circle One): Yes (N_j Don't know. IF you answered YES, then tell what 16. Did the object move in front of something at any time, particularly a cloud? (Circle One)r Yes Don' t know. IF you answered YES, then tell what 17. Tell in a few words the following things about the object: 18. We wish to know the angular size. Hold a match stick at arm's length In line with a known object and note how much of the"' object is covered by the heod of the match. If you had performed this experiment at the time of the sighting, how much of the object would hove been covered by the match head? 19. Draw a picture thot will show the shape of the object or objects. Lobel and include in your sketch any details of the object that you sow such as wings, protrusions, etc., and especially exhaust trails or vapor trails. Place on arrow beside the drawing f to show the direction the object was moving. ~ . Cl~. Page2 8. IF you saw the object at NIGHT, what did you notice concerning the STARS and MOON? 8. 1 STARS (Circle One): 8.2 MOON (Circle One): a . Bright Dull moonlight c. Many c. No moonlight-pitch dark d . Don' t re member d. Don't remember What were the weather conditions at the time you saw the object? CLOUDS (Circle One): WEATHER (Circle One): @')Clear sky a . Dry mist, or light rain c. Scattered clouds c. Moderate or heavy rain d. Thick or heavy clouds e. Don' t remember 1 0. The object appeared: (Circle One): G) Solid d. As a light b. Transparent e. Don't remember 11. If it appeared as a light, was it brighter than the brightest stars? (Circle One): a. Brighter c. About the same b. Dimmer d . Don't know 11.1 Compare brightness to some common object: 12. The edges of the object were: (Cirde One): a . Fuzzy or blurred e. Otherd t like a bright star Shorply outlined .:.c- L , aa d . Don' t remember 13. Did the object: a . Appeor to stand still at any time? b. Suddenly speed up and rush oway at any time? c. Break up into parts or explode? '"tc irdeOne to~c ;h-que~;l~) Don't know Ye No Don' t know No Don't know ive off smoke? Don' t know Yes No Don' t know f . Change shape? ~ .: _ ~ ,"Vvj . h. Disappear and reappear? Yes No Don't know Yes No Don' t know Don' t know U.S. AIR FORCE TECHNICAL INFORMATION This questionnaire has been prepared so that you can give the U.S. 1\ir Force as much information as possible concerning the unidentified aeriOI phenomenon that you have observed . Please try to answer as many questions as you possibly con. The Information that you g ive will be used for research purposes. Your name will not be used in connection with any statements, conclusions, or publications without your permission. We request this personal information so if it is deemed necessary, we may contact you for further details. 1. When did you see the object? Time of day: 3. Time Zone: (Circle One): o. Eastern c. Mountain d. Pacific (Circle One): (Circle One): a . Daylight Saving b. ~tondord'; 4 . Where were you when you sow the object? Nearest Postal Addren City or Town State or County 5. How long was object in sight? (Total Duration) Hour5 Minutes Seconds Certain c. Not very sure Fairly certain I d . Just a guess L1~ . I I 5.2 Was object in sight continuously? 6. What was the condition of the sky? a . Bright 7. IF you sow the object during DAYLIGHT, where was the SUN located as you looked at the object? (Circle One): o. In front of you d . Toyourleft In bock of you e . Overhead c. To your right f. Don't remember FTD OCT 62 164 1'hts IQrm SUJH'I'scdcs Jo"rD I tJ4, jul 61, which Is obsolete . Official U.S. Air Forcf. 34. Date you completed this questionnaire. Day -( Month Information which you feel pertinent and which Is not adequately covered In the eclfic paints of the questionnaire or a narrative explanation of your sighting UFO form continued i A rt/t.-u Official U.S. Air Foret 14. Did the object disappear while you were watching it? If so, how? 15. Did the object move behind something at any time, particularly a cloud? Yes Don't know. IF you answered YES, then tell whot 16. Did the object move in front of something at any time, particularly a cloud? (Circle One)t Yes Don't know. IF you answered YES, then tell what 17. Tell in a few words the following things about the object: We wish to know the angulor size. Hold a match stick at arm's length in line with a known object and note how much of the is covered by the head of the match. If you had performed this experiment at the time of the sighting, how much the object wouJd have been covered by the match head? 19. Draw a picture that will show the shape of the object or objects. Label and include in your sketch any details of the object that you saw such as wings, protrusions, etc., and especially exhaust trails or vapor trails. Place an arrow beside the drawing ta show the direction the abject was moving. UFO form continued 20. Do you think you can estimate the speed of the object? (Circle O"e) Yes If you answered YES, then what speed would you estimate? _ 21. Do you thin~ you can estimate how far away from you the object was? (Circle One) @ No IF you answered YES, then how far away would you say it was?-~ t.~!,.. t..-1C.A':.e. ~ .VU,"'' y 22. Where were you located when you sow the object? (Circle One): a . Inside a building t'(Outdo;i) d. In an airplane (type) 23. Were you (Circle One) a. In the business section of o city? b. In the residential section of a city? f ~n open countrysidV d. Near on airfield? e. Flying over a city? f. Flying over open country? 24. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the following questions: 2-'.1 What direction were you moving? (Circle One) a . North c. East e . South b . Northeast d . Southeast f. Southwest h. Northwest 24.2 How fast were you moving? miles per hour. 24.3 Did you stop at any time while you were looking at the object? (Circle One) Did you observe the object through any of the following? a . Eyeglasses Yes Nd e . Binoculars b. Sun glasses f. Telescope c. Windshield g . Theodolite Yes d . Window glass In order that you can give as clear a picture as possible of what you sow, describe in your awn words a common object or ob jects which, when placed up in the sky, would give the same appearance as the obje which you saw.