2023 Text Astronaut Candidate Selections Qualification Inquiry

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Paperwork Reduction Act Statement:

This information collection meets the requirements of 44 U.S.C 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. The OMB control number for this information collection is 2700-0156 and it expires on 04/30/2023. We estimate that it will take about xx minutes to read the instructions, gather the facts, and answer the questions. You may send comments on our time estimate above to Astronaut.Selection@nasa.gov. Send only comments relating to our time estimate to this address.

Privacy Act Statement

Pursuant to the Privacy Act of 1974, 5 U.S.C. § 552a, the following statement is furnished to individuals applying to become NASA astronauts.

Authority: This collection is authorized by 51 U.S.C. 20113(a), 44 U.S.C. 3101, and 5 U.S.C. § 3301 et seq.

Purpose: Records in this system are used by NASA to facilitate processes and procedures associated with the recruitment, evaluation, and selection of United States astronaut candidates, as defined in 14 CFR 1214, Subpart 1214.11 (NASA Astronaut Candidate Recruitment and Selection Program).

Routine Uses: Use and disclosure of records within and outside of NASA may occur in accordance with routine uses and NASA Standard Routine Uses described in the system of records notice (SORN), Astronaut Candidate Selection Records (NASA 10ACSR), published at https://www.federalregister.gov/documents/2015/12/23/2015-32289/privacy-act-of-1974-privacy-act-system-of-records and as permitted by the Privacy Act of 1974, as amended (5 U.S.C. 552.a(b)).

Effect of Nondisclosure: Supplying the information is voluntary on your part. However, failing to provide all or part of the information may prevent an accurate and timely decision on your application.

Welcome Page 1

Select Astronaut Candidate

Greetings!

The following Astronaut Candidates have applied to participate in the NASA Astronaut Candidate (ASCAN) Program, and have provided your name as a Professional/Personal Reference.

[CANDIDATE NAME (BUTTON)]

Please click the name of the candidate above for whom you would like to provide a reference, or click the CANCEL button below to disconnect.

[CANCEL BUTTON]

Welcome Page 2 (Change/Keep Username)

Welcome, [RESPONDENT NAME] Last Visit: MM/DD/YYYY at HH:MM:SS

Username Change Available

Our records indicate that your USERNAME is currently set to your EMAIL ADDRESS. For increased security, we recommend that you create a unique username for this website; however, making such a change is completely optional and at your discretion.

If you would like to change your username, enter it into the text field below and click the Change My Username button.

NOTE: If you prefer to continue using your email address as your username, simply click the Keep My Username button.

NEW USERNAME:* [TEXT FORM TO CHANGE NAME] [SUBMIT BUTTON]

* Username MUST begin with an ALPHABET, MUST contain at least ONE NUMERAL, MUST be 8 - 15 characters long, and MAY contain one or more non-consecutive "underscore (_)" characters.

Welcome Page 3 (After Change/Keep Username)

Welcome back, [RESPONDENT] Last Visit: MM/DD/YYYY at HH:MM:SS

Your input into the evaluation of NASA Astronaut Candidate [CANDIDATE NAME] will provide us with significant information used to determine their suitability for participation in the ASCAN program. We would appreciate you completing this evaluation as honestly and completely as possible. Additionally, there is space at the end of each section (except Section 1) for specific example narratives.

We respectfully request that you complete this inquiry by no later than [NLT Date], as this information is needed for selection activities that are currently underway. The time to complete this inquiry is estimated to be 20 minutes (depending on the length of your narrative responses); however, the system has been designed to retain your answers should you decide to complete it in stages. No attachments or separate documents will be considered outside of this form. NOTE: A copy of this Astronaut Candidate Qualifications Inquiry may be provided to the candidate, if requested in writing from the Astronaut Selection Office.

Thank you for your input! If you have any questions or concerns regarding this evaluation, or if you experience any problems, please send us an email at Astronaut.Selection@NASA.Gov, or call the NASA Astronaut Selection Office at +1 (281) 483-5907.

Sincerely,

Anne Roemer

Manager, Astronaut Selection Office

Completed Welcome Page (If respondent has completed the survey)

Select Astronaut Candidate

THANK YOU!

You have completed all Astronaut Candidate Professional/Personal References requested of you.

[IMAGE] NASA Thanks You

[Close and EXIT BUTTON]

Step 1

Progress for Candidate [CANDIDATE NAME] Logged in as: [RESPONDENT NAME]

Step 1 – Establish Reference History [PROGRESS TRACKING]

Step 2 – Rate Professional Capabilities [PROGRESS TRACKING]

Step 3 – Rate Personal Attributes [PROGRESS TRACKING]

Step 4 – Rate Leadership Skills [PROGRESS TRACKING]

Step 5 – Rate Teamwork Skills [PROGRESS TRACKING]

Step 6 - Rate Overall Impression [PROGRESS TRACKING]

Step 1 - Establish Reference History

How long have you known the applicant? [DROPDOWN TO SELECT “Years Known”]

In what capacity have you known the applicant? [DROPDOWN TO SELECT “Professional / Personal”]

May we contact you for additional information? [Yes / No RADIAL BUTTONS]

Step 2

Progress for Candidate [CANDIDATE NAME] Logged in as: [RESPONDENT NAME]

Step 1 – Establish Reference History [PROGRESS TRACKING]

Step 2 – Rate Professional Capabilities [PROGRESS TRACKING]

Step 3 – Rate Personal Attributes [PROGRESS TRACKING]

Step 4 – Rate Leadership Skills [PROGRESS TRACKING]

Step 5 – Rate Teamwork Skills [PROGRESS TRACKING]

Step 6 - Rate Overall Impression [PROGRESS TRACKING]

Step 2 - Rate Professional Capabilities

Please complete the following evaluations by providing a rating from 1 to 5 in each of the categories (1 is lowest, 5 is highest). If you have not observed the characteristic, please check the box marked N/A:

(Low) (High)

1 2 3 4 5 N/A

Technical - Quality, diversity and breadth of technical knowledge in their chosen profession

Experience - Quality, diversity and breadth of professional experience in their chosen profession

Operational - Has the capacity and technical skills to address real-time and possibly dynamic situations - can think on their feet

Planning - Establishes a plan, guided by resources, arranges and executes tasks efficiently to meet goals, and follows to completion

Situational Awareness - Is able to follow and understand the overall status of a situation based on available information - has the big picture

Judgment - Follows a logical and proper course of action based on best use of resources and information

If possible, please give examples of a time when the candidate exhibited these Professional Capabilities:

Step 3

Progress for Candidate [CANDIDATE NAME] Logged in as: [RESPONDENT NAME]

Step 1 – Establish Reference History [PROGRESS TRACKING]

Step 2 – Rate Professional Capabilities [PROGRESS TRACKING]

Step 3 – Rate Personal Attributes [PROGRESS TRACKING]

Step 4 – Rate Leadership Skills [PROGRESS TRACKING]

Step 5 – Rate Teamwork Skills [PROGRESS TRACKING]

Step 6 - Rate Overall Impression [PROGRESS TRACKING]

Step 3 - Rate Personal Attributes

Please complete the following evaluations by providing a rating from 1 to 5 in each of the categories (1 is lowest, 5 is highest). If you have not observed the characteristic, please check the box marked N/A:

(Low) (High)

1 2 3 4 5 N/A

Accountability - Responsibly completes assigned tasks, openly admits shortcomings and accepts responsibility for mistakes

Discipline - Functions within operational, regulatory, organizational and common sense guidelines

Self Improvement - Motivated to improve technical, professional and teamwork skills, and accepts and acts on feedback

Personal Conduct - Represents employer, colleagues and profession favorably

Tolerance - Displays an understanding and acceptance of other cultures, organizations, professions, etc.

Stress Management - Sustains personal capabilities and skills when a stressful or dynamic environment - stable

Communication - Openly and efficiently exchanges information, actively listens and respects dissenting views

Self Management - Understands personal limitations and knows how to maintain personal well being in unfamiliar situations or circumstances

Conscientiousness - Exhibits positive and constructive disposition, very motivated

If possible, please give examples of a time when the candidate exhibited these Personal Attributes:

Step 4

Progress for Candidate [CANDIDATE NAME] Logged in as: [RESPONDENT NAME]

Step 1 – Establish Reference History [PROGRESS TRACKING]

Step 2 – Rate Professional Capabilities [PROGRESS TRACKING]

Step 3 – Rate Personal Attributes [PROGRESS TRACKING]

Step 4 – Rate Leadership Skills [PROGRESS TRACKING]

Step 5 – Rate Teamwork Skills [PROGRESS TRACKING]

Step 6 - Rate Overall Impression [PROGRESS TRACKING]

Step 4 - Rate Leadership Skills

Please complete the following evaluations by providing a rating from 1 to 5 in each of the categories (1 is lowest, 5 is highest). If you have not observed the characteristic, please check the box marked N/A:

(Low) (High)

1 2 3 4 5 N/A

Leadership - Democratically directs and empowers a team to achieve goals while being respectful to all members of the team - not dictatorial

Instructing/Mentoring - Shares information, gives feedback, encourages team members to reach full potential - does not take credit for others efforts

Adaptive Leadership - Is able to adapt style of leadership if required by an unexpected or dynamic situation

If possible, please give examples of a time when the candidate exhibited these Leadership Attributes:

Step 5

Progress for Candidate [CANDIDATE NAME] Logged in as: [RESPONDENT NAME]

Step 1 – Establish Reference History [PROGRESS TRACKING]

Step 2 – Rate Professional Capabilities [PROGRESS TRACKING]

Step 3 – Rate Personal Attributes [PROGRESS TRACKING]

Step 4 – Rate Leadership Skills [PROGRESS TRACKING]

Step 5 – Rate Teamwork Skills [PROGRESS TRACKING]

Step 6 - Rate Overall Impression [PROGRESS TRACKING]

Step 5 - Rate Teamwork Skills

Please complete the following evaluations by providing a rating from 1 to 5 in each of the categories (1 is lowest, 5 is highest). If you have not observed the characteristic, please check the box marked N/A:

(Low) (High)

1 2 3 4 5 N/A

Followership - Loyal to the leader and team, and places team goals above personal goals - no personal agenda

Team Building - Develops appropriate relations with other team members, recognizes and minimizes any actions negative to other team members

Team Participation - Actively participates and contributes to team goals, acts as a team player

If possible, please give examples of a time or event when the candidate exhibited good Teamwork Skills:

Step 6

Progress for Candidate [CANDIDATE NAME] Logged in as: [RESPONDENT NAME]

Step 1 – Establish Reference History [PROGRESS TRACKING]

Step 2 – Rate Professional Capabilities [PROGRESS TRACKING]

Step 3 – Rate Personal Attributes [PROGRESS TRACKING]

Step 4 – Rate Leadership Skills [PROGRESS TRACKING]

Step 5 – Rate Teamwork Skills [PROGRESS TRACKING]

Step 6 - Rate Overall Impression [PROGRESS TRACKING]

Step 6 - Rate Overall Impression

Please give your overall impression of the candidate for a stressful and high visibility position:

• Do not Recommend

• Some Doubts and Reservations

• About Average

• Better than Average

• Definitely Superior

Please provide any additional comments or insight you might have on this candidate:

Completion Step (If respondent is a reference for more than one candidate)

Inquiry Completed!

Thank you for completing this Astronaut Candidate Qualifications Inquiry. Your responses to the questions are very important to the selection process.

You have [1, 2, 3…] candidate reference(s) remaining.

Click the name of the candidate below to continue, or click the Submit and Logout button below to come back later.

[CANDIDATE1 NAME]

[CANDIDATE2 NAME]

[CANDIDATE3 NAME]

.

.

.

[Submit and Logout (BUTTON)]

Completion Step (If respondent is a reference ONLY one candidate)

Inquiry Completed!

Thank you for completing this Astronaut Candidate Qualifications Inquiry. Your responses to the questions are very important to the selection process.

Should you have any questions concerning this inquiry, please do not hesitate to call the NASA Astronaut Selection Office at 281-483-5907, or send us an email at Astronaut.Selection@NASA.GOV.

Thank you for your help.

Sincerely,

Anne Roemer

Manager, Astronaut Selection Office

Common to all pages (Header and Footer)

Header:

Astronaut Candidate Qualifications Inquiry

The astronauts of the 21st century

will continue to work aboard the International Space Station; help to build and fly a new NASA vehicle, the Orion Multi-Purpose Crew Vehicle (MPCV); and further efforts to provide a commercial capability for transportation to the space station.

Footer:

National Aeronautics and Space Administration NASA Official: Anne Roemer || Curator: Sam Henry

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Version: 01.00.00, Last Updated: 06/20/2016