SHARE SPIRITUAL SPECTRUM EXPERIENCES

OBERF Home Page
Experience Stories
Share Experience (Web Form)
 


Spiritual Spectrum Experience 
(Spontaneous OBE, NDE-Like, or Other Spiritually Transformative Event)
Questionnaire



Scroll down to find the Experiencer Questionnaire or click shortcut below :

Fill-in- the-blank Form
(Questionnaire Form, Preferred)
OR
Narrative Form
(E-mailing your account is great!  But for research methodology, it is even better if we can tabulate the results from the questionnaire form above)



Overview:

Experiences may be submitted to us (in order of preference):

            1.    Via the form on the OBERF web site.

            2.    Via e-mail (see the bottom of each page).  

 While we greatly appreciate experience contributions, we regret there can be no monetary compensation to contributors. Confidentiality of all communications will be strictly maintained to the extent desired by the contributor..

We have a series of questions, and will also record aspects of the experience not covered by our questions. We expect these will be modified over time to help us more accurately understand NDE and related experiences.  Completing these questions will take at least 30 minutes.

Your willingness to share your experience is vital to the success of this project. We express our heartfelt thanks in advance to those willing to share!



Experiencer Questionnaire

Fill in the Blank (for electronic submission) Form


Form Instructions:


1.    Please fill out the form below as completely and accurately as you can.  We will honor the confidentiality of your submission at the level you specify in the following form.

2.     It may be necessary to enter the same information in several boxes.  You may re-type the information (preferred, copy & paste as appropriate) or reference a previous question number containing the response to the current question (example): "see #7".

3.    Please do not forget to press the "Submit" button at the end or the information will be lost! 

4.    If you have time constraints, you may share in several partial submissions over time.  Complete only previously non-submitted portions of the form each time. If you are sharing in this manner, please complete the last box (contact information) each time you submit.  This will allow us to consolidate all portions you have shared.

5.    After you press the submit button, a review of your responses to the questions will be shown.  A button will allow you to return to this page.  The form will be blank, but all information will have been sent.  If you noted any errors, please fill out only the parts of the form to be corrected, and submit again.   If you have any questions or concerns please E-mail us.

6.    I wish the account of my experience to be placed in the OBERF archives.  I understand it may be read by students or researchers who have been approved by OBERF for use of the archives.  My account may be excerpted or used in full, or data may be drawn from it in conjunction with an OBERF approved study or project, including but not limited to lectures or educational programs relating to Spiritual Spectrum Experiences, or part of a published article, or in a book.  My name will not be give express permission to do so.  THANKS!!!

7.  To prevent spammers and other inappropriate uses of this form, we have a special request:
     Please type "lynx" (case sensitive) in the first question immediately below, labeled as a Page Validation Question:

=====================================================================================================================

1.  Page Validation Question: Type "lynx" in the box:  

Name:

Postal   Address:
Telephone:
E-Mail:


Contact restrictions (if any) & instructions:
No contact whatsoever
A researcher approved by NDERF may contact me.  If so, I can still choose at that time not to be interviewed and not to participate.  I may change this approval for contact at any time.


If I approve of contact, the following are any restrictions or preferred method(s) of contact (if any):

Experience publication restrictions (if any) & instructions:

With any individual or organization approved by OBERF (website, media or publication):

*NOTE: Please make sure your web browser and e-mail service do not place nderf@nderf.org or blueheron78@yahoo.com in spam, delete or reject status - otherwise we can't contact you.  Also, we never send attachments.  Do NOT open attachments from either of these e-mails because they contain viruses and are spoofing (not from us)!

HOW PUBLISH

Select (or de-select) as many below as apply:

Under no circumstances

Anonymously (without my name)

With my E-Mail address

With my name (first name and last initial)

With my address


WHERE PUBLISH

Website only

Media, publication, and website (Will notify if a part of the story is used other than the website so long as we have a current e-mail address)

Please ask permission to use the story in places other than the website.  If e-mail is not kept current (bounces), a grant of permission is assumed.


Date of experience:


Age at time of experience:


Age now:


Location of experience (city or county, state, country if not U.S.A.):

You are:
Female     Male

Condition around the time of experience:

Clinical death (cessation of breathing or heart function or brain function)
Life threatening event, but not clinical death
Illness, trauma or other condition not considered life threatening
Other (briefly specify):


Circumstances around the time of experience (Check all that apply):

Accident Illness Surgery-related
Childbirth Heart attack Allergic reaction
Suicide attempt Combat Criminal attack
Other (briefly specify):


Status of health after experience:
Excellent      Good      Fair      Poor

Status of health now:
Excellent      Good      Fair      Poor


Did your experience include (check all that apply):

Out of body experience Presence of unearthly beings
Light Presence of deceased persons
Darkness A landscape or city
Void Boundary
Strong emotional tone Special Knowledge
Life review Vision of the future
Features consistent with your beliefs at the time
None of the above


Has your experience resulted in changes in any of the following (check as many as apply):

Personal relationships Belief system
Job or studies Physical aftereffects
Increased sensitivity, healing or psychic abilities Feelings about family, friends or society
Feelings about death Sense of life purpose
None of the above

Have these changes resulting from your experience been:
Positive      Disturbing      Mixed

Over time, did these changes resulting from your experience:
Increase      Decrease       Stay about the same

Your current principal occupation:


Your main interests and hobbies:


Your religious background at time of experience (Faith/denomination (or 'None'):
Conservative/fundamentalist        Moderate        Liberal


Your religious background currently (Faith/denomination (or 'None'):
Conservative/fundamentalist         Moderate        Liberal


Race (check as many as apply):
Caucasian    Black    Hispanic    Asian      Native American
Other:

Country of birth:


Was your experience(s) consciously and deliberately induced?


After your experience, did you consider the contents of your experience:
Wonderful    Frightening     Mixed

Highest level of education (1-12 for grades 1-12, then add 1 for each         additional year of post High School education):

Were there any associated medications or substances with the potential to affect the experience? 
No     Yes     Uncertain     No response
   If yes or uncertain, please explain:

2.  Was the kind of experience difficult to express in words?
No     Yes     Uncertain     No response
    If yes or uncertain, what was it about the experience that makes it hard to communicate?


3.  At the time of this experience, was there an associated life threatening event?
No     Yes     Uncertain     No response
   If yes or uncertain, describe:


4.  Please describe your experience using as much detail as you can and as much space as you need (scroll bars allow unlimited amount of writing):

5. What was your level of consciousness and alertness during the experience?

    Was the experience dream like in any way?

6.    Did you experience a separation of your consciousness from your body?
No     Yes     Uncertain     No response
    If yes or uncertain, describe your appearance or form apart from your body.

7. What emotions did you feel during the experience?

    Please include your feelings, if relevant, to events you describe in your answers to the following questions.

8. Did you hear any unusual sounds or noises?

9. LOCATION DESCRIPTION:  Did you recognize any familiar locations or any locations familiar from religious teachings ie. Heaven, Hell, Hades, etc.?  Did you encounter any locations inhabited by incredible or amazing creatures?

No     Yes     Uncertain     No response
    If yes or uncertain, describe.

10. Did you see a light?
No     Yes      Uncertain     No response
    If yes or uncertain, describe.

11. Did you meet or see any other beings?
No     Yes      Uncertain     No response
    If yes or uncertain, describe. Where were they? Did you know them? What was communicated?

12. Did you experiment while out of body or in another altered state?  For example did you attempt to visit a family member or friend at another location?  Did you eyewitness an event that you would not have known about had you not been out of body?  Did you attempt to move a physical object while in the astral/etheric universe? 
No     Yes     Uncertain     No response
      If yes or uncertain, what did you do and what was the result of the experimentation? 

13. Did you observe or hear anything regarding people or events during your experience that could be verified later?
No     Yes     Uncertain     No response
    If yes or uncertain, describe.  How did you verify this?

14. Did you notice how your 5 senses were working, and if so, how were they different?
No     Yes     Uncertain     No response
    If yes or uncertain, describe.

15. Did you have any sense of altered space or time?
No     Yes     Uncertain     No response
    If yes or uncertain, describe.

16. Did you have a sense of knowing, special knowledge, universal order and/or purpose?
No     Yes     Uncertain     No response
    If yes or uncertain, discuss and share what you came to know.

17. Did you reach a boundary or limiting physical structure?
No     Yes     Uncertain     No response
    If yes or uncertain, describe. Did you cross the boundary? If yes, describe. If no, did you have a sense of what would happen if you did cross the boundary?

18. Did you become aware of future events?
No     Yes     Uncertain     No response
   If yes or uncertain, describe.  Based on your life following the experience, how accurate was this awareness?

19. Were you involved in or aware of a decision regarding your return to the body?
No     Yes     Uncertain     No response
    If yes or uncertain, describe, including your emotions at that time.

20. Did you have any psychic, paranormal or other special gifts following the experience you did not have prior to the experience?
No     Yes     Uncertain     No response
   If yes or uncertain, describe.

21. Did you have any changes of attitudes or beliefs following the experience?
No     Yes     Uncertain     No response
    If yes or uncertain, describe.

22. How has the experience affected your relationships? Daily life? Religious practices? Career choices?

23. Have you shared this experience with others?
No     Yes     Uncertain     No response
    If yes, What were their reactions? Were they influenced in any way by your experience? How?

24. What emotions did you experience following your experience?

25. What was the best and worst part of your experience?

26. Is there anything else you would like to add concerning the experience?

27.    Has your life changed specifically as a result of your experience?
No     Yes     Uncertain     No response
    If yes or uncertain, and if not answered above, please describe:


28. Following the experience, have you had any other events in your life, medications or substances which reproduced any part of the experience?
No     Yes     Uncertain     No response
    If yes or uncertain, describe.

29. Did the questions asked and information you provided accurately and comprehensively describe your experience?
No     Yes     Uncertain     No response
    Explain.

30.   Please offer any suggestions you may have to improve this questionnaire.  Are there any other questions we could ask to help you communicate your experience?

Page Validation Question: Make sure to type "lynx" in question #1 at the top of the form or the form won't go through

   Thanks!!!

 
Remember to Submit completed form! 
 


Last revised: March 13, 2013

Experiencer Narrative Form 

Questions

Be sure to send your e-mail address!

1.  What is your name, address, telephone, e-mail address     
       What is your level of confidentiality - 
                Permission to publish?  
                    If so, anonymously or with your first name?
                    Do you wish your e-mail address to be posted?
                Permission to contact you?  
        If so, preferred method of contact by e-mail, snail mail?  
        Would you be willing to participate in future OBERF approved research studies?

2.    Please provide the events surrounding your experience including the approximate date and location. Please include your gender, current age and highest levels of education. Were there any associated medications or substances with the potential to affect the experience? Were you knowingly attempting to end your life?

3.    Was the kind of experience difficult to express in words?
    If yes, What was it about the experience that makes it hard to communicate?

4.    At the time of this experience, was there an associated life threatening event?      If yes, describe.

5.    What was your level of consciousness and alertness during the experience?      Was the experience dream like in any way?

6.    Was there any medical evidence of cessation of breathing or heart function?

7.    Did you experience a separation of your consciousness from your body?      If yes, describe your appearance or form apart from your body.

8.    Describe in detail the events (in order) that happened.

9.    What emotions did you feel?      Please include your feelings, if relevant, to events you describe in your answers to the following questions.

10.    Did you hear any unusual sounds or noises?

11.    Did you pass into or through a tunnel or enclosure?    If yes, describe.

12.    Did you see a light?      If yes, describe.

13.    Did you meet or see any other beings?      If yes, describe. Where were they? Did you know them? What was communicated?

14.    Did you experience a review of past events in your life? Describe in detail. 
    Did you learn anything you did not have previously know? Please provide details. Did you learn anything that helps you live your life now?

15.    Did you observe or hear anything regarding people or events occurring while you were unconscious that could be verified later?      How did you verify this?

16.    Did you see or visit any beautiful or otherwise distinctive locations, levels or dimensions?      If yes, describe.

17.    Did you have any sense of altered space or time?

18.    Did you have a sense of knowing universal order and/or purpose?      If yes, discuss and share what you came to know.

19.    Did you reach a boundary or limiting physical structure?
    If yes, describe. Did you cross the boundary? If yes, describe. If no, did you have a sense of what would happen if you did cross the boundary?

20.    Did you become aware of future events in your life?
    If yes, describe. Based on your life following the spiritual spectrum experience, how accurate was this awareness? 

21.    Were you involved in or aware of a decision regarding your return to the body? If yes, describe, including your emotions at that time.

22.    Did you have any psychic or paranormal gifts following the experience you did not have prior to the experience?    If yes, describe.

23.    Did you have any changes of attitudes or beliefs following the Experience?      If yes, describe.

24.    How has the Experience affected your relationships? Daily life? Religious practices etc.? Career choices?

25.    Have you shared this experience with others?      If yes, What were their reactions? Were they influenced in any way by your Experience? How?

26.    What emotions did you feel experience following your experience?

27.    What was the best and worst part of your Experience?

28.    Is there anything else you would like to add concerning the Experience?

29.    Following the Experience, have you had any other events in your life, medications or substances which reproduced any part of the experience?

30.    Did the questions asked and information you provided accurately and comprehensively describe your Experience?

31.    Please offer any suggestions you may have for these questions to help us understand spiritual spectrum experiences?

32.  Is there anything else you would like to add concerning the experience or any aspect of the circumstances surrounding it?  Please offer any suggestions you may have for this form that would help us or others in our mutual search to understand the experience in the spectrum of spiritual experiences?

    Thank you again for your willingness to share your spiritual spectrum experience!  If you know any other experiencers, please encourage them to share their experience as well.


e-mail: nderf@nderf.org  Webmaster:  Jody A. Long Staff Emails

Jody A. Long Professional Websites
Jody A. Long's Family Law web site: www.attyfamilylaw.com; Jewelry by Jody www.jewelrybyjody.com
 

Hit Counter (From 10/20/02)

Copyright1999 by Dr. Jeff & Jody Long .  All rights reserved.