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Dream Submittal Form

The Lifetreks staff appreciates your participation in this research project. Completed forms (all required fields entered) are reviewed on-line to see if your dream contains any of the hundreds of dream symbols identified by Dr. Holloway. Potential dream symbols found in completed forms will be identified and brief summary definitions will be provided for a limited number of symbols.

One dream may be selected for special focus by Dr. Holloway. If your dream is selected and you have given your permission for the dream to be used as the featured Dream of the Month, your dream will be posted with comments by Dr. Holloway.

  1. If your dream was a short story, what would you title it?:

  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 (Events later transpired in real life.)
    Provided Realization (Catalyst of a valuable understanding.)
    Seemed Real (More like a real experience or event, than a dream.)
    Spiritual Experience (Religious encounter, or spiritual significance.)
    None (none of the above characteristics apply)

  9. Select the applicable category(ies) for your dream:
    Anomalous (There is an element of abnormality or deviation from the regular or usual.)
    Nightmare (Highly unpleasant, frightening, or disturbing.)
    Psychic (There is an element of extrasensory perception.)
    Recurring (A repetitive dream, or dreams of the same theme.)
    Sexual (There is an element of sex organs, functions, instincts, or drives.)
    None (none of the above categories apply)

  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

    Age: (at the time of the dream)

    Gender/Sex: Male      Female

    Which of the following best describes where you were and how you felt when you had the dream?

  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:

  14. May we use your dream as Dream of the Month?: Yes No
    If yes, then please give us a name to use, and an e-mail address if you would like to be notified:
    Anonymous/Pen Name:
    E-mail Address:

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