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After Death Communication (ADC)
Questionnaire Introduction

Scroll down to find the ADC Questionnaire Questions in:
Narrative Form

Fill in the Blank Form  
(Or Scroll Down)

For Electronic Submission, Preferred

Overview:

Further comments regarding this project are in the section "Experience Sharing Project Overview

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

    1.  Via the form on the ADCRF web site.

    2.  Via e-mail (see the bottom of each page, or "Contact ADCRF" section of this web).  It would be preferred, but not required, for your e-mail correspondence to address the questions in the form below in order .  Above all, share in whatever way you are comfortable with.

    3.  Via our mailing address (see the bottom of each page, and "Contact ADCRF" section of this web).  Again, It would be preferred, but not required, for your written communication  to address the questions below in order .

 We are now able to provide the service of calling experiencers to allow them to verbally share.   If you are an experiencer who would prefer not to submit your experience in writing, please e-mail us with your contact information, best time to call, time zone, any restrictions on calling, etc.  THANKS!

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 expect this  questionnaire will be modified over time to help us more accurately understand ADC 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!

ADC Questionnaire
Narrative Form

Overview- Narrative Form

Please feel free to e-mail us an account of your experience (see the bottom of each page, and "Contact ADCRF" section of this web).  It might be helpful to look over the questions in the form below.  Be sure to include as much detail as you can!  Remember that details you believe are unimportant may be very significant.  

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


ADC Questionnaire Form

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 (or 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 first 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 ADCRF archives.  I understand it may be read by students or researchers who have been approved by ADCRF 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 ADCRF approved study or project, including but not limited to lectures or educational programs relating to After Death Communication, or part of a published article, or in a book.  My name will not be used unless I 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 "onyx" (case sensitive) in the first question immediately below, labeled as a Page Validation Question:

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

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

Name:

Postal   Address:

Telephone:
E-Mail:

You are:
Female Male

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 ADCRF (website, media or publication):

*NOTE: Please make sure your web browser and e-mail service do not place nderf@nderf.org  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.

Have you had multiple experiences?
No Yes     Uncertain     No response
If yes , how many experiences?

    If yes, and only several experiences, please consider completing this form for each experience.  If more than several, or if you prefer, please complete this form regarding your most meaningful or significant experience.

How many deceased or other beings were present in the experience?


    Only if multiple deceased or other beings, and if possible, please answer the following questions in this format: On each line, identify the deceased, comma after their name, then respond to the question.  For example the next question could be responded as:
    Mary, Mother
    Joe, Uncle (Father's side)
    Sue, Close friend


The following are questions about the deceased.  If you are not sure of the exact answer, but have a reasonably approximate answer, please give the approximate answer.  If you have no idea of the answer, please enter "unknown".  If you do not wish to respond to the question, please enter "no response" or "NR".

Name of the deceased:


Relation of deceased to you (i.e. father, son, friend, neighbor, etc.):


Do you have any comments about the relationship you had with the deceased?


Former occupation of deceased:


Cause of death of the deceased:


Age of deceased at time of death:


Today's Date (Date you submitted this experience):


Date of experience:


Length of time between death of deceased and your experience:


Was the date of the experience significant in any way (for example: anniversary, holiday, birthday, critical time in life, etc.):


Your age at time of experience:


Your age now:


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

Details of location of experience and your activity at time of experience (for example: sleeping, in reading in bed in bedroom, at funeral of deceased, driving a car to work, cooking in kitchen, etc.):

 

Degree of bereavement for deceased immediately prior to the experience (choose best response):

No sadness and/or grief feelings
Slight sadness and/or grief feelings
Moderate sadness and/or grief feelings
Moderately severe sadness and/or grief feelings
Severe sadness and/or grief feelings
No response


Degree of alertness immediately prior to experience (choose best response):

Fully alert
Slightly drowsy
Very drowsy
Asleep
No response


Was the experience witnessed or experienced by others?
    No     Yes     Uncertain     No response
    If Yes or Uncertain, describe:


Your current principal occupation:


Your main interests and hobbies:


Your religious background at time of experience (Faith/Denomination, or 'None'):
Conservative/fundamentalist  Moderate  Liberal    Uncertain   None 
              No Response     Describe below if more explanation is needed.


Your religious background currently (Faith/Denomination, or 'None'):
Conservative/fundamentalist  Moderate  Liberal     Uncertain   None 
              No Response     Describe below if more explanation is needed.


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

Country of birth:


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):

1.  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.  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, text will automatically scroll at right end of box):

4.  Did you ONLY sense an awareness or presence of the deceased without actually seeing, hearing, feeling or smelling them (if you saw, heard felt or smelled them, check 'No')?

No Yes     Uncertain     No response
   

5.  Did you hear the deceased or hear something associated with the deceased?
No Yes     Uncertain     No response

    If No, please click here to scroll down to the next question (#6).
    If Yes or Uncertain:
        Describe what you heard, how clearly you heard it and what was communicated:


        Did the voice or sound seem to originate externally or outside of you, inside you, or did you not hear a voice or sound, but had a sense of knowing what was communicated?  Please describe.


        If you heard a voice or sound, was it similar or dissimilar from the voice or sound the deceased made when they were alive?


       Is there any possibility what you heard was from any other source present in the surroundings at the time of your experience?


        Was there any possible impairment to your hearing at the time of the experience? 
 

6.  Did you feel a touch or experience any physical contact from the deceased?
No Yes     Uncertain     No response
   
If No, please click here to scroll down to the next question (#7).
    If Yes or Uncertain:
        Where and how were you touched?


        Was the touch familiar or unfamiliar?  Describe.


        Was anything communicated by the touch?  Describe.


        Is there any possibility what you felt was from any other source present in the surroundings at the time of your experience?  


7.  Did you see the deceased?
No Yes     Uncertain     No response
   
If No, please click here to scroll down to the next question (#8).
    If Yes or Uncertain:
        Describe the appearance of the deceased, and comment on any similarities and differences in how they appeared from their appearance when alive:


        How clearly did the deceased appear (i.e. solid, somewhat transparent, etc.):


        How much of the deceased did you see (i.e. all or part of the deceased):


        Did the deceased appear or not appear to be the age at which they died?  Describe.


        How healthy did the deceased appear to be?  Did they have any infirmities before they died which might have been apparent or not apparent?  Describe.


        Is there any possibility what you saw was from any other source present in the surroundings at the time of your experience?


8.  Did you smell a distinct smell, scent, fragrance or odor associated with the deceased?
No Yes     Uncertain     No response
   
If No, please click here to scroll down to the next question (#9).
    If Yes or Uncertain:
        What smell, scent, fragrance or odor did you smell?  Describe.


        Was the smell, scent, fragrance or odor familiar?  Describe.


        Was anything communicated by the smell?  Describe.


        Is there any possibility that the smell, scent, fragrance or odor was from any other source present in the surroundings at the time of your experience?


9.  How long did the experience last?


10.  Was the beginning and end of the experience gradual or more sudden?  Describe.


11.  Could you sense the emotions or mood of the deceased? 
No Yes      Uncertain     No response
     If Yes or Uncertain, Describe.


12.  Did the deceased give you information you did not previously know?  Describe in detail.  If you received any information whether true or not true, helpful or not helpful, please describe in detail.


13.  Prior to the experience, did you believe in after death communication? (choose the best response, to the best of your recollection):

        Absolutely
        Believed it probably could happen
        Believed it not likely to happen
        Absolutely not
        No response

14.  Prior to the experience did you believe in the possibility of life after death (choose the best response, to the best of your recollection):

        Absolutely
        Believed it probably could happen
        Believed it not likely to happen
        Absolutely not
        No response

15.  Prior to the experience did you believe in the existence of God or a Supreme Being (choose the best response, to the best of your recollection):
      
  Absolutely
        Believed God probably exists
        Believed God does not likely exist
        Absolutely not
        No response

16.  Prior to the experience were you afraid of death (choose the best response, to the best of your recollection):
        Very fearful
        Moderately fearful
        Slightly fearful
        Not fearful
        No response

17.  After your experience, do you believe in after death communication? (choose the best response, to the best of your recollection):
        Absolutely
        Believed it probably could happen
        Believed it not likely to happen
        Absolutely not
        No response

18.  After your experience do you believe in the possibility of life after death (choose the best response, to the best of your recollection):
        Absolutely
        Believed it probably could happen
        Believed it not likely to happen
        Absolutely not
        No response

19.  After your experience do you believe in the existence of God or a Supreme Being (choose the best response, to the best of your recollection):
    
    Absolutely
        Believed God probably exists
        Believed God does not likely exist
        Absolutely not
        No response

20.  After your experience are you afraid of death (choose the best response):
        Very fearful
        Moderately fearful
        Slightly fearful
        Not fearful
        No response

21.  How do you currently view the reality of your experience (choose the best response):
        Experience was definitely real
        Experience was probably real
        Experience was probably not real
        Experience was definitely not real
        No response

Please explain why you view the reality of your experience as real or not real.


Was the experience dream like in any way?
No Yes      Uncertain     No response
     If Yes or Uncertain, Describe.

22.  What did you feel (while awake) immediately prior to your experience (check as many as apply):

Relaxed Happy Grieving
Sad Suicidal Angry
Confused No particular emotion No response


23.  Describe in detail your feelings/emotions during the experience:

 

24.  What emotions did you experience following your experience?

25.  Was there any emotional healing in any way following the experience?  
No Yes      Uncertain     No response
    If Yes or Uncertain, describe:


26.  What other attitudes and beliefs about your experience do you currently have (Check all that apply):

Sacred Hallucination Delusion
Life-changing Fantasy Dream
No particular attitude Fear Joy
Other (briefly specify):

27.  Did the experience give you any spiritual understandings such as life, death, afterlife, God, etc.?  
No Yes      Uncertain     No response
    If Yes or Uncertain, please describe:


28.  "Death Compacts" are when two or more living people promise among themselves that whoever dies first will try to contact the other(s).  Have ever made such a compact? 
No Yes      Uncertain     No response
    If Yes or Uncertain, please describe the compact.  Was the deceased in your experience included in the compact?


29. 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?

30. Did you experience a separation of consciousness from your body?
No Yes     Uncertain     No response
If Yes or Uncertain, describe.

31. Did you meet or see any other beings other than the deceased?
No Yes     Uncertain     No response
If Yes or Uncertain, describe.

32. Did you see a light?
No Yes     Uncertain     No response
If Yes or Uncertain, describe.

33.  Did any part of your experience seem to occur in a place other than the location described above?
No Yes     Uncertain     No response
If Yes or Uncertain, describe.

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

35. 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.

36. 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?

37. 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.

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

39. Has your life changed specifically as a result of your experience? 
No Yes     Uncertain     No response
If Yes or Uncertain, describe how.  (For example:  Has the experience affected your relationships?  Daily life?  Religious practices etc.?  Career choices?) 

40. 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?

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

42. Have you shared this experience formally or informally with any other researcher or web site?
No Yes     Uncertain     No response
If Yes or Uncertain, please describe:



43.
Is there anything else you would like to add regarding your experience?

44. 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.

45.  Did you ever in your life have a near-death experience, out of body experience or other spiritual event?  
No Yes      Uncertain     No response
    If Yes or Uncertain, describe:

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

47. 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 "onyx" in question #1  at the top of the form or the form won't go through

Thanks!!!

  Remember to Submit completed form!

Forum:  You may wish to join our forum at www.nderf.me to talk about your experience or interest with like-minded people.


 


Last revised: February 16, 2014

e-mail: adcrf@adcrf.org  Webmaster:  Jody A. Long

 

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