DD Form 1721-1 Space Test Program Flight Request Executive Summary

DD Form 1721-1 - also known as the "Space Test Program Flight Request Executive Summary" - is a Military form issued and used by the United States Department of Defense.

The form - often incorrectly referred to as the DA form 1721-1 - was last revised on September 1, 2006. Download an up-to-date fillable DD Form 1721-1 down below in PDF-format or find it on the Department of Defense documentation website.

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UNCLASSIFIED
DATE (YYYYMMDD)
SPACE TEST PROGRAM FLIGHT REQUEST EXECUTIVE SUMMARY
1. EXPERIMENT TITLE
2. SHORT TITLE/ACRONYM
3. EXPERIMENT NUMBER
4. OBJECTIVE
5. DESCRIPTION (Include web site if applicable)
6. RELEVANCE TO SPECIFIC DOD REQUIREMENTS (Include list of key relevant source documents)
7. REQUIREMENTS SUMMARY
d. FLIGHT DURATION
a. EXPERIMENT
b. REQUESTED STP SERVICES
PIGGYBACK FLIGHT
c. REPETITIVE OR
REQUIRED
OTHER (Sounding Rocket, Balloon,
INCREMENTAL
INSTRUMENT
LAUNCH SERVICES/INTEGRATION
(Months)
Micro-G Flight, etc.) (Specify):
COMPLETE
SPACECRAFT ACQUISITION
YES
NO
SPACECRAFT
OPERATIONS/DATA DISTRIBUTION
(If Yes, number):
e. FLIGHT MODE (1=Preferred, 2= Acceptable, UA=Unacceptable)
f. POWER (W)
STAND-BY:
NOMINAL:
MAXIMUM:
FREEFLYER
SHUTTLE
ISS
OTHER
h. MASS (kg)
i. VOLUME (cc)
j. HARDWARE FLIGHT READY DATE (MMM-YYYY)
g. DIMENSIONS (cm)
X
X
l. ORBIT REQUIREMENTS (km)
m. INCLINATION (degrees)
k. STABILIZATION TYPE
APOGEE
+
-
+
-
PERIGEE
+
-
n. OTHER REQUIREMENTS
8. PROGRAM SUMMARY
a. EXPERIMENT FUNDING ($Millions Needed / $Millions Secured)
SOURCE
PRIOR FY FUNDS
CURRENT FY FUNDS
FUTURE FY FUNDS
TOTAL COST
0.00
0.00
/
/
/
/
0.00
0.00
/
/
/
/
0.00
0.00
/
/
/
/
0.00
0.00
/
/
/
/
0.00
0.00
/
/
/
/
b. DESIGN/FABRICATION STATUS
c. CONTRACTOR
9. SERVICE/AGENCY APPROVAL
a. APPROVING OFFICIAL (Last Name, First, Middle Initial)
b. OFFICE SYMBOL
c. POSITION
d. MAILING ADDRESS (Street, Apartment/Suite No., City, State, ZIP Code)
e. TELEPHONE NUMBER(S) (Include Area Code)
COMMERCIAL
DSN
f. SIGNATURE
g. EMAIL
h. PRINCIPAL INVESTIGATOR (Last Name, First, Middle Initial)
i. OFFICE SYMBOL
j. POSITION
k. MAILING ADDRESS (Street, Apartment/Suite No., City, State, ZIP Code)
l. TELEPHONE NUMBER(S) (Include Area Code)
COMMERCIAL
DSN
m. SIGNATURE
n. EMAIL
DD FORM 1721-1, SEP 2006
PREVIOUS EDITION IS OBSOLETE.
Adobe Professional 7.0
Reset
UNCLASSIFIED
DATE (YYYYMMDD)
SPACE TEST PROGRAM FLIGHT REQUEST EXECUTIVE SUMMARY
1. EXPERIMENT TITLE
2. SHORT TITLE/ACRONYM
3. EXPERIMENT NUMBER
4. OBJECTIVE
5. DESCRIPTION (Include web site if applicable)
6. RELEVANCE TO SPECIFIC DOD REQUIREMENTS (Include list of key relevant source documents)
7. REQUIREMENTS SUMMARY
d. FLIGHT DURATION
a. EXPERIMENT
b. REQUESTED STP SERVICES
PIGGYBACK FLIGHT
c. REPETITIVE OR
REQUIRED
OTHER (Sounding Rocket, Balloon,
INCREMENTAL
INSTRUMENT
LAUNCH SERVICES/INTEGRATION
(Months)
Micro-G Flight, etc.) (Specify):
COMPLETE
SPACECRAFT ACQUISITION
YES
NO
SPACECRAFT
OPERATIONS/DATA DISTRIBUTION
(If Yes, number):
e. FLIGHT MODE (1=Preferred, 2= Acceptable, UA=Unacceptable)
f. POWER (W)
STAND-BY:
NOMINAL:
MAXIMUM:
FREEFLYER
SHUTTLE
ISS
OTHER
h. MASS (kg)
i. VOLUME (cc)
j. HARDWARE FLIGHT READY DATE (MMM-YYYY)
g. DIMENSIONS (cm)
X
X
l. ORBIT REQUIREMENTS (km)
m. INCLINATION (degrees)
k. STABILIZATION TYPE
APOGEE
+
-
+
-
PERIGEE
+
-
n. OTHER REQUIREMENTS
8. PROGRAM SUMMARY
a. EXPERIMENT FUNDING ($Millions Needed / $Millions Secured)
SOURCE
PRIOR FY FUNDS
CURRENT FY FUNDS
FUTURE FY FUNDS
TOTAL COST
0.00
0.00
/
/
/
/
0.00
0.00
/
/
/
/
0.00
0.00
/
/
/
/
0.00
0.00
/
/
/
/
0.00
0.00
/
/
/
/
b. DESIGN/FABRICATION STATUS
c. CONTRACTOR
9. SERVICE/AGENCY APPROVAL
a. APPROVING OFFICIAL (Last Name, First, Middle Initial)
b. OFFICE SYMBOL
c. POSITION
d. MAILING ADDRESS (Street, Apartment/Suite No., City, State, ZIP Code)
e. TELEPHONE NUMBER(S) (Include Area Code)
COMMERCIAL
DSN
f. SIGNATURE
g. EMAIL
h. PRINCIPAL INVESTIGATOR (Last Name, First, Middle Initial)
i. OFFICE SYMBOL
j. POSITION
k. MAILING ADDRESS (Street, Apartment/Suite No., City, State, ZIP Code)
l. TELEPHONE NUMBER(S) (Include Area Code)
COMMERCIAL
DSN
m. SIGNATURE
n. EMAIL
DD FORM 1721-1, SEP 2006
PREVIOUS EDITION IS OBSOLETE.
Adobe Professional 7.0
Reset

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