First Name: Last Name:

Address: City: State/Province: Country: ZIP/Mail Code: Phone#: Email: Date of birth (mm/dd/yyyy): I wish my data to be kept confidential yes no

Your gender: Where are you from? What is your ethnic background? What socioeconomic group would you say represents your family of origin? What is your socioeconomic group now? What religion, if any were you brought up with What religion do you observe now, if any?

1) Which form of spiritual expression do you feel best describes you (Please see below)? Ambivalent Hedonist Devotional Mysterious Rationalist Contemplative-rationalist Eclectic-rationalist Eclectic-ecstatic Charismatic-Contemplative Integrated-Contemplative None of the above
A) Ambivalent: Are you ambivalent toward religion and spirituality? Do you emphasize conformity and avoid passion, faith and religious exuberance? This means that you may go to temple once a week, and on the ritual cycle, just like everyone else in your culture. This form of spirituality in this culture is typified by mainstream Protestant Christianity, or Reform Judaism, but every culture has its ambivalent religious forms.

B) Hedonist: Are you more oriented toward a hedonistic religion, where you may reject or deemphasize piety, ethics, discipline and scholarship while emphasizing “crazy wisdom,” where you look to an experiential spiritual experience through singing, dance, fire worship, snake handling or consuming mind-altering drugs? The groups and religions that fall into this class are Apostolic Christians, Pagans, the Donme Kabbalists, Shivaite Hindus, and the followers of Rajnish, Choygum Trungpa, Da Free John, etc.

C) Devotional: Do you consider yourself more oriented toward a faith-based or devotional form of religion typically with an emphasis upon ethics, such as Born-Again Protestant Christianity, Vaishnava Hinduism, Pureland Buddhism or mainstream Islam, in which you reject or deemphasize the practice of contemplation and meditation, while emphasizing religious faith and devotion?

D) Mysterious: Are you more oriented toward a religion that emphasizes the fantastic or mysterious. These forms of religion very often emphasize ritual behavior? The schools that emphasize this form of religion would be the Theosophical Society, Elizabeth Clare Prophet, or one of the various Tantric schools, such as Tibetan Buddhism.

E) Rationalist: Are you more oriented toward a rationalist religion, where religious devotion, piety, ethics, ritualized behavior, the practice of meditation and gnosis are generally deemphasized, while intellectual and philosophical forms of expression and practice are emphasized? The schools that emphasize this form of religion are the Jesuit Catholics, mainstream Protestantism, Hindu gnana yoga, as well as atheist.

F) Contemplative-rationalist: The members of this school are those who practice meditation, however they reject any attainment of meditative absorption. In Buddhism the stoic schools are Theravadan and Zen Buddhism. The Christian contemplatives who reject meditative absorption states would be here as well.

G) Eclectic-rationalist, who rejects meditative absorption: These people follow 2 or more religious belief systems, however, they tend to reject meditative absorption. Typical of this group would be the many New-Age forms of religious expression.

H) Eclectic-ecstatic, who embrace meditative absorption: This category would include those who follow two, or more paths such as absorption (shamata) and insight (vipassana), such as the Thai Forest Tradition; or those who have found meditative absorption through one or more of the above path models but remain with those path models while enjoying meditative absorption?

I) Ecstatic or Charismatic Contemplative: Are you more oriented toward cultivating meditative absorption states, such as jhana and samadhi? The schools that emphasize this form would be the GWV, Sant Mat or the Carmelites.

J) Integrated-contemplative tradition where meditative absorption is an integral part of the path, but it is not considered the ultimate goal or the end of the path. Examples might be the Thai Forest tradition of Theravadan Buddhism, or Tibetan Buddhism where calm abiding (shamata) is emphasized but not the focus.

K) None of the above

If you selceted "None of the above" then please define your religious, spiritual or philosophical point of view.

2) Do you feel you lead a contemplative life? (A contemplative life is one that is engaged in a regular religious or spiritual activity, such as any one or more of the following: prayer and/or meditation; following some kind of ethical standard, such as the 10 commandments or the Buddhist precepts; some kind of religious study, such as the canon and commentaries of one’s chosen religion or contemplative tradition; and self observation.) yes no

3) If so, what? Please describe.
4) How long have you engaged in this activity?
5) How frequently do you engage in this activity? Is this contemplative activity a daily practice? If not how often do you engage in contemplative activities?
6) How long is your typical contemplative session?
7) What do you do and/or not do, during these contemplative sessions, please explain?
8) Have you engaged in other spiritual activities? yes no
9) If so, what, when, how often and for how long?
10) Do you experience meditative absorption (jhana/samadhi)? yes no don't know

We would like to know what portions of that experience you have on a regular basis during meditation:
11) I regularly experience access concentration (upacara-samadhi). yes no

12) While in meditative absorption I experience applied, initiating or discursive thoughts. yes no
13) While in meditative absorption I experience sustained discursive thoughts. yes no
14) While in meditative absorption I experience intermittent thoughts. yes no

15) I regularly experience one-pointedness (Ekaggatha) when I meditate. yes no
16) I regularly experience pleasant sensations (piiti) when I meditate. yes no
17) I regularly experience joy (sukha) when I meditate. yes no
18) I regularly experience a calm or tranquil mind (Passaddhi) when I meditate. yes no
19) I regularly experience dispassion or equanimity, which is typically described as having rich feelings but your mind is not drawn to any single detail of the sensory domain (Upekkha) when I meditate. yes no
20) I regularly experience subtle non-sensory phenomena that I recognize as a characteristic of absorption (jhana-nimitta), such as chirping or ringing, or various vibratory sensations on the skin, or luminosity, and/or a sweet smell, and/or a sweet taste and/or feeling as if I am floating when I meditate. yes no

21) Please describe:
22) I regularly experience the feeling of being so free from anxiety and stress as if I could meditate forever (Asukha ca Adukkha). yes no
When I meditate it seems like my breath stops. yes no
23) I experience hyper-real luminous orbs when I meditate. yes no
24) How often do these phenomena occur for you?

25) Do you experience charismatic phenomena (such as OOBs, auras, chakras, kundalini, kriyas raptures of various kinds, bliss, ecstasy, jhana, samadhi, visions, charismatic ringing, etc.)? yes no

26) Do you feel non-physical sensation of “energy” in your hands (stigmata)? yes no
27) Do you feel non-physical sensation of “energy” in your feet (stigmata)? yes no
28) Do you feel non-physical sensation of “energy” in your chest? yes no
29) Do you feel non-physical sensation of “energy” in your throat? yes no
30) Do you feel non-physical sensation of “energy” in your forehead? yes no
31) Do you feel non-physical sensation of “energy” in your crown of the head? yes no
32) Do you feel non-physical sensation of “energy” (aura) around your body? yes no
33) Do you experienced hyper-real non-physical realities either during meditation or during sleep? yes no

34) Do you hear non-physical (charismatic) sounds Clairaudience, Divine ear (dibba-sota)? yes no
35) Do you on occasion become aware of the thoughts and/or intensions of others as in mental telepathy (ceto-pariya-ñána)? yes no
36) Have you recalled, or re-lived, previous lifetimes (paticcasamuppada)? yes no

37) Do you experience clairvoyance, divine eye (dibba-cakkhu) “sees beings passing away & re-appearing” (cutúpapáta-ñána)? yes no
38) Have you ended mental agitation? yes no
39) Have you found joy (sukha)? yes no
40) Have you found bliss (piiti), which are pleasant non-physical sensations in meditation? yes no

41) Do you experience Fearlessness? yes no

42) Have you penetrated the path to enlightenment (dhamma-vicaya)? yes no
43) Have you found charismatic energy (viriya, vîrya, Kundalini, iddhi-páda)? yes no
44) Have you found “knowledge and vision (nanadassana)? yes no

45) What is the nature of the charismatic phenomena that you experience? (The kinds of experiences we are interested in are non-normal phenomena, such as OOBs, auras, chakras, kundalini, kriyas raptures of various kinds, bliss, ecstasy, jhana, samadhi, visions, charismatic ringing, etc.) Please explain how they manifest in your case.
46) When did these phenomena first occur? How frequently do they occur? Do they still occur?
47) What do you believe is the cause and/or origin of these phenomena?
48) What do you believe stimulates and suppresses the frequency and intensity of these phenomena?
49) Do you believe it might be possible to improve or intensify these subjective (charismatic) experiences? If so, how?

50) Are you a healing professional who practices some form of energy healing, such as Rieki, Jin Shin, Cranial Sacral work, etc. yes no

51) If yes, please describe:

52) Have you ever taken mind-altering drugs, specifically psychedelics, such as LSD, mushrooms, or peyote? yes no

53) If so, what, when and how often do you still take psychedelics?

Sleep activity

54) Do you dream? If so, how often?

55) How much sleep do you receive each day?
56) Have you ever had a dream in which you knew you were dreaming, which is the definition of a lucid dream? yes no
57) Have you ever had a hyper-real dream or OOB? If so when and how often?

58) Do you lose consciousness during the sleep cycle? yes no

59) I do not experience any of the above phenomena while in meditative.

Many contemplatives claim they were dismissed, marginalized or demonized by their meditation teachers or priests for their meditation experiences. We would like to know, if you have found meditative absorption (jhana), how were you treated by your Non-GWV meditation teachers, priests or community?
60) I was empowered for my meditation experiences. yes no
61) I was honored for my meditation experiences. yes no
62) I was respected for my meditation experiences with jhana. yes no
63) My meditation experiences were validated by my meditation teachers and/or priests. yes no
64) The meditation teacher or priest was ambivalent about my meditation experiences. yes no
65) My priest, teacher or community dismissed my meditation experiences s something to be ignored. yes no
66) I was marginalized by my priest, teacher or community for my meditation experiences. yes no
67) I was demonized for my meditation experiences. yes no

If you do not want to leave your name, please leave something, such as a pseudonym that we can use to identify your record with.
68) Do we have your permission to post your bio on the GWV website? yes no

Through the attainment of meditative absorption (jhana) the following have: increased, decreased, stayed the same or been removed:
69) Sensual desires and sexual addiction have: increased / decreased / stayed the same / or been removed
70) Hostility, ill will and aversion have: increased / decreased / stayed the same / or been removed
71) Restlessness, remorse, tension, stress and anxiety have: increased / decreased / stayed the same / or been removed
72) Apathy, sloth, torpor and unconsciousness have: increased / decreased / stayed the same / or been removed
73) Skepticism and doubt have: increased / decreased / stayed the same / or been removed
74) Obsession with physical existence has: increased / decreased / stayed the same / or been removed
75) Obsession with heavenly existence has: increased / decreased / stayed the same / or been removed
76) Ignorance has: increased / decreased / stayed the same / or been removed
77) Clan identification and/or ethnocentricity has: increased / decreased / stayed the same / or been removed
78) Dogmatic, clinging to rules, rights, rituals and beliefs has: increased / decreased / stayed the same / or been removed
79) Delusion has: increased / decreased / stayed the same / or been removed
80) Depression has: increased / decreased / stayed the same / or been removed
81) Mania or an excessively intense enthusiasm, interest, or desire has: increased / decreased / stayed the same / or been removed .
82) Eating disorders have: increased / decreased / stayed the same / or been removed
83) Obsessions, or a compulsive preoccupation with a fixed idea or an unwanted feeling or emotion, often accompanied by symptoms of anxiety have: increased / decreased / stayed the same / or been removed .
84) Compulsions, or an irresistible impulse to act, regardless of the rationality of the motivation, have: increased / decreased / stayed the same / or been removed .
85) Psychosomatic illnesses have: increased / decreased / stayed the same / or been removed
86) Covetousness and greed have: increased / decreased / stayed the same / or been removed
87) Envy has: increased / decreased / stayed the same / or been removed
88) Vanity and narcissism have: increased / decreased / stayed the same / or been removed
89) Arrogance has: increased / decreased / stayed the same / or been removed
90) Obsession for power has: increased / decreased / stayed the same / or been removed
91) Obsession for fame has: increased / decreased / stayed the same / or been removed