NDE Project
Gay/Lesbian/Transgender
NDE Project
Near-Death Experience (NDE)
Gay/Lesbian/Transgender Questionnaire Introduction
Please consider participating in the first Internet based study organized within the gay community. There are many important lessons to be learned from understanding Near Death Experience (NDE).
All information shared as part of this study is confidential to the degree requested by you. This study will involve completing an Internet questionnaire form regarding your experience (will take about 45 minutes). This questionnaire is open to anyone who has been Gay/Lesbian/Bisexual/Transgender at any time in their life. We welcome contributions from all individuals regardless of sexual orientation. For those who are not Gay/Lesbian/Bisexual/Transgender, please contribute your experience in the "Share NDE" section with linked via the button on the left.
For
the purpose of this study, NDE is defined as:
“A
lucid experience associated with perceived consciousness apart from the body
occurring at the time of actual or threatened death”.
With
your advance permission (from the Internet form) we would be happy to E-mail
back your submission, with all questions on the Internet form and your
responses. You may then share your
experience submission in written form with anyone you wish.
We regret there can be no other compensation for participation in this
study. Results of this study will
be periodically published (anonymously) to this web site (a non-profit web
site). Thank you in advance
for your willingness to participate in this important study!
This
project is a collaboration of two major NDE researchers:
Dr.
Liz Dale is a Clinical Psychologist, NDE researcher and author of a book
regarding gay NDE. Please contact
Liz for further information about this study at lizdale1@juno.com.
Dr. Jeff Long is a Physician, and webmaster of this web site. Dr. Long serves on the Board of Directors of IANDS (International Association for Near-Death Studies). Please contact Dr. Long for further information about this study via E-mail at nderf@nderf.org.
NDE Questionnaire
Thank you again for your willingness to share your NDE experience! If you know any other NDE experiencers, please encourage them to share their experience as well.
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 unsubmitted 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 NDERF
archives. I understand it may be read by students or researchers who have
been approved by NDERF for use of the archives, and the co-investigators of this
study (Dr. Liz Dale and Dr. Jeffrey Long, see above). My account may be
excerpted or used in full, or data may be drawn from it in conjunction with an
NDERF approved study or project, including but not limited to lectures or
educational programs relating to Near-Death Experience, or part of a published
article, or in a book. My name and any contact information will not be used unless I give express
permission to do so. THANKS!!!
| 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 NDERF (website, media or publication): |
Under no circumstances Select (or de-select) as many
below as apply: With my E-Mail address With my name With my address |
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 biologically:
Female
Male
Sexual identity prior to experience (check the one best response):
Gay Lesbian
Bisexual
Transgender
Heterosexual
Sexual
identity not established No
response
Comments on sexual identity prior to experience:
Sexual identity currently (check the one best response):
Gay Lesbian
Bisexual
Transgender
Heterosexual
Sexual
identity not established No
response
Comments on sexual identity currently:
During your experience, were you aware of your own or others sexual identity?
No Yes Uncertain
No
response
If yes or uncertain, describe. Please include in detail all
communications, interactions or understandings during your experience
pertaining to sexual identity:
Did the experience change your sexual identity in any way or change the way
you feel about your sexual identity?
No Yes Uncertain
No
response
If yes or uncertain, describe.
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:
Country (ies) of family origin:
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. Did you pass into or through a
tunnel or enclosure?
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 experience a review of
past events in your life?
No Yes Uncertain
No response
Describe in detail. Did you learn anything you did not
previously know? Did you learn anything that helped
you live your life after the experience?
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 see or visit any
beautiful or otherwise distinctive locations, levels or
dimensions?
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 etc.? 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?
Thanks!!!
Remember to Submit completed form!
Caution... Reset button will erase ALL data entered!
Copyright
1999
by Dr. Jeffrey P. Long
e-mail:
nderf@nderf.org
Webmaster: Jody A. Long, JD
Jody A. Long, JD &
Jeffrey Long, MD (of NDERF) Professional Websites
Jody A. Long's Family Law web site:
www.attyfamilylaw.com;
Jewelry by Jody
www.jewelrybyjody.com
Dr. Jeffrey Long's Radiation Oncology (the use of
radiation to treat cancer) web site:
www.rooj.com
(From 3/20/00)