Astronaut Training Licensing Form
Please complete this form to apply for astronaut training licensing.
Full Name
First Name
Last Name
Date of Birth
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Highest Level of Education
Please Select
High School Diploma
Associate Degree
Bachelor's Degree
Master's Degree
Doctorate
Previous Experience in Aviation or Space Industry
Physical Fitness Certification (Upload)
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Do you have any medical conditions that may affect training?
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