Section 1 Background information
Sex: Male | Female Other(specify)____________________
Sexual preference: Straight | Bisexual | Gay/Lesbian
Age: 7-13 | 14-20 | 21-27 | 28-34 | 35-41 | 42-48 | 49-55 | 56-62 | 63<
Ethnic Background: European | Asian | Pacific Islander | African | Middle Eastern | Native American | Latin American
Section 2 Identity
I am a: (circle however many apply) Native Religionist | Neopagan | Witch | Wiccan | Druid | Subgenius | Buddhist | Taoist | Catholic | Christian | Shaman | Discordian | Jewish | Hindu | Agnostic | Atheist | Moslem | Other (specify)_______________________________________________
I consider myself religious. Yes | No
I consider myself spiritual Yes | No
I am a member of a: (circle however many apply) No group Circle | Coven | Grove | Spirituality group | Church | Temple | Mosque | Community | Tradition | Other (specify)____________________________________
Are you now, or have you ever been, in a 12-step program? Yes | No
Section 3 Belief
I believe that science is a valid way of learning about the physical world. Yes | No
I believe that science is not adequate to explain all of human experience. Yes | No
I believe in Absolute Truth Yes | No
I define Absolute Truth as: _________________________________________________________________
I believe in a power greater than myself that takes an interest in my well being. Yes | No
I believe that God(desses): are not real | physically exist | exist in a non physical way | only exist metaphorically | are useful / harm full | I believe in one God(dess) Yes | No
I believe in The Lord and The Lady Yes | No
I believe in many God(desses) Yes | No
I believe that all God(desses) are equally valid Yes | No
I believe that Divinity is immanent in all things Yes | No
I define God(dess)(es) as: __________________________________________________________________
I believe in life after death. Yes | No
I believe in reincarnation Yes | No
I believe in sin. Yes | No
I define Sin as: _________________________________________________________________
I believe in the Three Fold Law Yes | No
Section 4 Practice
I believe that rituals are useful Yes | No
I attend rituals Yes | No
I have some Priest/ess training Yes | No
I am an ordained Priest/ess Yes | No
I am a practicing Priest/ess Yes | No
A Priestess is: __________________________________________________________
I believe that Magic works. Yes | No
Magic is: ______________________________________________________________
I have cast spells. Yes | No
A Spell is: ____________________________________________________________
I use a particular ritual form Yes | No
A ritual is: ____________________________________________________________
I cast a circle Yes | No
I call quarters Yes | No
I invoke Deity(es) Yes | No
Section 5 Psychic Phenomenon
I believe in ghosts Yes | No
I believe in Spirits Yes | No
I believe that some people have psychic abilities. Yes | No
I believe that all people have psychic abilities. Yes | No
I believe that I have psychic abilities Yes | No
I have precognitive experiences (see the future) Never | Sometimes | Frequently | Always
I have Deja Vu (the feeling that a new person, place or experience is familiar Never | Sometimes | Frequently | Always
A person I am thinking of calls or visits me Never | Sometimes | Frequently | Always
Street lights go out when I get near them. Never | Sometimes | Frequently | Always
Watches stop or behave oddly when I wear them Never | Sometimes | Frequently | Always
I know when something is wrong with one of my friends or family without seeing them or being told. Never | Sometimes | Frequently | Always
I experience non physical entities (ghosts, spirits). Never | Sometimes | Frequently | Always
I can see auras Never | Sometimes | Frequently | Always
I have prophetic dreams. Never | Sometimes | Frequently | Always
I naturally have one lock of pale hair among otherwise dark hair. Yes | No
My eyebrows grow together over the bridge of my nose. Yes | No
I have a "Widows Peak Yes | No
I am Left/Right Handed.
Section 6 If there are any questions you think we should have asked or ideas you feel should be explored further or thoughts that you wish to express or expand on please use this space to do so.
© Eva M. Snyder last updated 8/22/01
For more information contact:
sheherazahde@yahoo.com