Questionnaire
Research into “Homo Noeticus” Star Children
Indepth history questionnaire for those who want to explore
more fully after completing the two previous questionnaires

Personal History Sheet   -   CONFIDENTIAL

    
           
Name:   Date:  
Address:   Age:  
    Marital Status  
    No of Children:  
    Ages:  
Tel/Home:   Tel/Work:  
Email:   Fax No:  
Occupation:      
 
   
1. Have your parents, siblings or children had Contact Experiences?

 

 

 
2. What have you read or seen, either in the media or film about Contact?
      Please list below.

 

 

 
3. What religious / spiritual upbringing did you have, if any? 

 

 

 

4. Have you shared your experiences with:

    a) Family or friends?

    b) A Health Professional?

 

 

 
5. Have you experienced any mental health problems? If so, can you briefly
      explain below

 

 

 
6. What issues do you feel you need help with on a scale from 1 to 10 -
      ie 1 = Not too difficult, - 10 = Extremely difficult


a)  Fear - what do you fear most?


b)  Isolation?


c)  Any other issues?

 

 
7. Are you aware if you have any High Sense Perceptions? - ie Psi (ESP skills, such as:    
      (please tick)


a)  Clairvoyance, seeking spirits, extraterrestrials or energies ?

 

b)  Clairaudience, hearing inner voices ?

 

c)  Telepathy, aware of tuning into other peoples' thoughts ?

 

d)  Precognition, seeing future events ?

 

e)  Out of body experiences (OBEs) astral travelling ?

 

f)  See energy or colours around people, often called auras ?
8. Do you feel you may have implants in your body? Yes / No -
      (if yes, where do you feel they are located)

 

 

 
9. Have you noticed any unusual marks or scars on your body that you cannot explain ?

 

 

 
10. Have you experienced any unusual pregnancies or miscarriages ?    If so, how many ?

 

 

 
11. Have you ever experienced 'missing time' or 'extended' time episodes?  
      If so could, you give a brief description?

 

 

 
12. Can you remember any unusual occurrences, such as clothing, ie 'nightwear' being
      mislaid or rearranged or changed in some way? If so, give a brief description.

 

 

 
13. How many different kinds of non-human beings do you think you have seen?  
      Brief descriptions

 

 

 
14. What kinds of interaction do you feel or know you have had?


a) Healing performed on you, if yes please give a brief account

 

 

b) Other medical procedures…. If yes please give a brief account:

 

 

c) Information given to you, verbally or telepathically, if yes please give brief account:

 

 

d) Educated in some way…..if yes, can you give a brief account:

 

 


e) Any other kinds of interactions you recall please specify and give brief account?
15. What support do you feel would be most helpful to you in order of importance
      i.e. 1 = Not So Important - 10 = Very Important


a) Sharing experiences?

b) Information?

c) Buddy telephone support?

d) Coping strategies?

e) Self healing techniques?

f) Techniques to help you to facilitate understanding of what Contact means to you?
16) Have you found that you have any creative desire to draw unusual art work,
        scripts, symbols, or speak in an unusual language ? If so, please relate details
        such as age you began doing this, and in what form you expressed it.

 

 

 
17) Can you briefly write an account of any conscious memories you may have of
        your Contact? For example …


a) How often you feel you have Contact experiences?
b) What are your earliest memories of Contact?

 

 

 
18) Phobias, such as:


a) Arachnophobia (fear of spiders)

b) Agoraphobia (fear of open spaces)

c) Elevators, or long passageways

d) Medical procedures, especially needles?

e) Excessive fear of the dark even as an adult?

 
19) Any other information you feel maybe relevant add here:

 

 

 

Please complete the same questions for any other children that you might have, no matter
how young they are.


Have you any of this documentation ie pictures, symbols, scripts (written languages) that
you/and they are prepared to photocopy and share for this research.     If so please send to:


ACERN
33, Watsonia Road,
Gooseberry Hill, 6076
Perth,
West Australia

Tel/fax International (618) 9454 3702
Email starline@iinet.net.au
Web address www.maryrodwell.com & www.acern.com.au

AWAKENING How Extraterrestrial Contact Can Transform Your Life
Resources with two chapters on the Star Children.