Occult Activities and Manifestations Survey

Name:___________________________ Identification Number:___________
Age:_____  Sex:_________ Marital Status:______________________
Years of Education:______________ Occupation:_________________________
Church Affiliation:____________________________________



Please examine the following lists of experiences.  If you have ever had the experience, or if you still have it, circle "yes."  If you have never had the experience, circle "no."  If you are not sure, circle "unsure."  Please use the space beneath the item to describe the experience, if you have had it.  Please describe when it happened, how often, where, under what conditions, etc. Use the back of the form for additional space, if necessary.

1.   Teleportation (spirit-mediated movement of a person from one location to another) Yes No Unsure
2.   Apportation  (spirit-mediated movement of an object from one location to another) Yes No Unsure
3.   Astral travel/projection  (feeling like your soul travels in the spirit world) Yes No Unsure
4.   Telekinesis  (moving a distant object with so-called "mental power") Yes No Unsure
5.   Psychokinesis  (moving an object with so-called "mental power") Yes No Unsure
6.   Levitation Yes No Unsure
7.  Seeing into or through objects Yes No Unsure
8.   Episodes of unusual physical strength Yes No Unsure
9.   Marked changes in personality or mood Yes No Unsure
10. Changes in voice Yes No Unsure
11.  Out-of-body or near-death experiences Yes No Unsure
12.  Foaming at the mouth Yes No Unsure
13.  Telepathy (communication through means other than human senses) Yes No Unsure
14.  "Alien abduction" Yes No Unsure
15.  Seeing visions of someone who is dead Yes No Unsure
16.  Hearing the "voice" of someone who is dead Yes No Unsure
17.  Poltergeists (spirits making their presence known by making noise or by moving objects) Yes No Unsure
18.  Precognition/clairvoyance/clairaudience/clairsentience (knowledge of something prior to its happening;  perceiving things beyond the human senses) Yes No Unsure
19.  Altered states of consciousness without alcohol/other drugs Yes No Unsure
20.  Hostility to, or rejection of God, Jesus of Nazareth, or the Holy Spirit Yes No Unsure
21. Hostility to, or rejection of, the Bible Yes No Unsure
22.  Atheism/agnosticism Yes No Unsure
23.  "Psychic" transference of power Yes No Unsure
24.  Spirit possession Yes No Unsure
25.  Seeing ghosts/apparitions (ghostly figures) Yes No Unsure


Copyright 1996 Rex W. Rosenberg
All Rights Reserved