First Name
Last Name
School	- no selection - Millard North High Millard South High Millard West High Papillion-La Vista Westside High Abraham Lincoln Westside Middle School
Grade	4th 5th 6th 7th 8th 9th 10th 11th 12th Other
E-mail

Please rate your abilities on the scale below
( 1 - Very good, 5 - Very bad)

Stay on Task	1 2 3 4 5
Dependability	1 2 3 4 5
Make Decisions	1 2 3 4 5
Organizational Skills	1 2 3 4 5
Communication Skills	1 2 3 4 5
Cooperation	1 2 3 4 5
Computer Knowledge	1 2 3 4 5

First Choice	Flight Director / Commander Navigator / Pilot Medical Team Meteorology Team Earth Observation Team Mars Observation Team Payload Team Nebraska Historical Team Public Affairs Office
Second Choice	Flight Director / Commander Navigator / Pilot Medical Team Meteorology Team Earth Observation Team Mars Observation Team Payload Team Nebraska Historical Team Public Affairs Office
Third Choice	Flight Director / Commander Navigator / Pilot Medical Team Meteorology Team Earth Observation Team Mars Observation Team Payload Team Nebraska Historical Team Public Affairs Office

Why do you feel you are qualified for this position? What experiences have you had that would benefit you?

Please list one reference: