ABOUT YOUR DREAMS            SUBMIT YOUR DREAM

  1. What would you title your dream?:

  2. When did you have this dream?:
    Year:     Month:     Day:

  3. Please describe your dream (in 450 words or less):
  4. Comments about your dream (optional):
  5. What, if any, significant life event occurred before the dream?:
  6. What, if any, personal concerns and issues occurred before the dream?:
  7. What, if any, associations and conclusions have you made at this time?:
  8. Select the applicable characteristic(s) of your dream:
    Dream Came True 
    Provided Realization 
    Seemed Real 
    Spiritual Experience 
    None
  9. Select the applicable category(ies) for your dream:
    Anomalous 
    Nightmare 
    Psychic 
    Recurring 
    Sexual 
    None
  10. Personal Information: (Please check all that apply to you.)
    I meditate regularly.
    I have a spiritual or religious practice.
    Other family members have had psychic experiences.
    I have noticed an increase in unusual or lucid dreams lately.
    None (none of the above apply)
  11. Stress may be an important factor.
    Yes      No stress in my personal life during the week before the dream.
    Yes      No stress in my vocation/occupation during the week before the dream.
  12. Please provide some demographic information:
    What was your primary vocation/occupation category during the week before you had the dream?:
    Administrative Artist Clergy
    Fire Fighter Homemaker Law Enforcement
    Management/Supervision Medical Care Provider Mental Health Services
    Military Professional Services Retired
    Sales/Purchasing Secretarial/Clerical Self Employed
    Service Industry Skilled Trades Social Services
    Student Teacher Technical Analyst/Specialist
    Other:
  13. What city or landmark were you in (or near) at the time of the dream?
      Within North America OR Outside North America
    City or Landmark:  
    State or Province:  
    Country:  

    Name:
    Address:
    Address 2:
    City:
    State:
    Zip:
    Phone:
    E-Mail:

    14. By submitting this form I certify that I am 18 years of age or older.