NDE Additional Questions

NDE Questionnaire
Additional Questions

Thanks in Advance for Your Willingness to Share!

Back to:

NDERF Research

NDERF Home Page

Near-Death Experience (NDE)
Additional Questions Introduction

Ten (10) additional questions are below. The only redundant questions are name, contact information and confidentiality request questions. All information shared as part of this study is confidential to the degree you request. We have been doing this type of investigation for nearly two years, and never had a complaint or breach of contributor's confidentiality. We welcome contributions from all individuals who previously completed the questions on the Share Experience portion of this web site. For further introductory comments, please see the Web Submission Overview section, or the introductory comments in the Share Experience section.

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. Please do not forget to press the "Submit" button at the end or the information will be lost!
3.    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.
4.    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. 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:	Home Page Current NDEs Share NDE

1. 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):

2. Experience publication restrictions (if any) & instructions:

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

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

Under no circumstances

Anonymously (without my name)

With my E-Mail address

With my name

With my address

Home Page Current NDEs Share NDE

3.    I have previously submitted my experience on the Share Experience form on this web site:
No     Yes     Uncertain     No response
(If no, please complete this section as well as the more detailed
questionnaire in the Share Experience section).

4.    My experience suggested to me that a special relationship may
exist between two or more beings on earth:
No     Yes     Uncertain     No response
If Yes or Uncertain, describe. Please describe in detail the nature and
significance of the special relationship:

5.    My experience suggested to me that a special relationship may
exist between two or more beings on non-earthly realms:
No     Yes     Uncertain     No response
If Yes or Uncertain, describe. Please describe in detail the nature and
significance of the special relationship. Please describe any association between non-earthly and earthly realm relationships:

6.    You are biologically:
Female     Male      No response

7.    Sexual identity prior to experience (check the one best response):
Heterosexual      Gay    Lesbian    Bisexual    Transgender       Sexual identity not established    No response

Comments on sexual identity prior to experience:

8.    Sexual identity currently (check the one best response):
Heterosexual     Gay    Lesbian    Bisexual    Transgender Sexual identity not established    No response

Comments on sexual identity currently:

9.    During your experience, were you aware of your own or others sexuality or 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 sexuality or sexual identity:

10.    Did the experience change your sexuality or sexual identity in any way or change the way you feel about your sexuality or sexual identity?
No     Yes     Uncertain     No response
If Yes or Uncertain, describe.

Thanks!!!

Remember to Submit completed form!
^{Caution... Reset button will erase ALL data entered!}

Last revised: October 13, 2017

e-mail: 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

Hit Counter (From 6/17/00)