JSC Form 726 (Rev Jul 97) (PerForm Pro Plus Jan 96) National Aeronautics and Space Administration Lyndon B. Johnson Space Center Houston, TX 77058-3696 Astronaut Candidate Qualifications Inquiry REFERENCE: The above named individual has applied for a position in NASA's Astronaut Candidate Program. In evaluating an applicant for the Astronaut Candidate Program, it is important that we have the benefit of qualitative information and advice from persons who have been directly associated with the applicant. Your name was given by the applicant as a person who can provide this necessary information and advice. We would appreciate you completing this evaluation to the best of your knowledge and ability. Your frank evaluation will be of significant assistance to us in determining the applicant's suitability for selection as an astronaut candidate. A copy of the announcement describing the position and the Astronaut Candidate Program is enclosed to aid you in completing this inquiry. Please answer the questions as fully and specifically as you can. If you need additional space for your comments, please attach a separate sheet of paper. A postage-paid envelope is enclosed for your reply, or you can fax the form to us at (281) 483-8626. Since this information is needed for selection activities currently underway, your prompt completion and return of this inquiry is requested. A copy of this Astronaut Candidate Qualifications Inquiry will be provided to the applicant, if the applicant requests it in writing. Should you have any questions concerning this evaluation, please do not hesitate to call me at (281) 483-5907. Thank you for your cooperation. Sincerely, Duane L. Ross, Manager Astronaut Selection Office 1. Applicant's Position Applicant's Organization ____________________________ ______________________________ Dates Employed Your Position: From: To: o Superior/Supervisor o Subordinate ___________ ___________ o Co-Worker o Other (Specify): ______ 2. Competence in Professional Functions Not Well Don't Suited Adequate Qualified Superior Know Theoretical Research Experimental Research Design and Development Operations Teaching Other (specify) 3. Subject-matter fields or specialties in which applicant is qualified Best ____________________________________ Next ____________________________________ Also ____________________________________ Circle the appropriate number on the rating scales, and add qualifying phrases as need to make clear your meaning. 4. Quality of professional background Below par | Adequate | Better than | Exceptional | Don't know | | most | | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 5. Interest in strengthening and broadening technical background Weak or | Moderate | Strong | Intensive | Don't know casual | interest | | drive | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 6. Ability to understand and assimilate scientific and technical material Somewhat | Good | Quick and | Exceptional | Don't know limited | | thorough | capacity | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 7. Application, effort, productivity Often needs | Generally | Diligent | A prime | Don't know prodding | satisfactory | | mover | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8. Resourcefulness, imagination, originality, creativity Unoriginal | Sometimes has | Frequently | Very fertile | Don't know | good ideas | original | and creative | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 9. Professional integrity Generally | Occasionally | High | Notably rig- | Don't know low integrity | lax or faulty | standards of | orous & pos- | | | integrity | itive integ. | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 10. Has applicant made any significant creative research or development contributions? Yes, as follows Not to my knowledge 11. Check all items below which are generally characteristic, deleting or adding terms Good follower or assistant ____ Cooperative team worker ____ Needs little guidance ____ Tends to irritate others ____ Clear, articulate ____ Tends to be erratic ____ Competent leader ____ Works best alone ____ Needs close supervision ____ Diplomatic, persuasive ____ Unclear, inarticulate ____ Dependable, steady ____ 12. Does applicant have any weaknesses or undesirable characteristics, personal or professional, omitted from or inadequately covered above by the preceding items? Yes, as follows Not to my knowledge 13. Does applicant have any strong points or desirable characteristics, personal or professional, omitted from or inadequately covered by the preceding items? Yes, as follows Not to my knowledge 14. Over-all fitness for professional work as an astronaut candidate Cannot Some doubts or About Better than Definitely One of the Recommend reservations average average superior very best Comments, or continuation of other items 15. If your answer to either of the following questions is "yes" please give full details Yes No A. Do you have any reason to question this person's loyalty to the United States? B. Do you have knowledge of any behavior or activities which tend to show that this person is not reliable, honest, trustworthy, and of good conduct and character? Date Position or title Signature