Age _________________

Gender ______________        MOST RECENT DREAM

Date Today __________


We would like you to write down the last dream you remember having, whether
it was last night, last month, or last year.  But first please tell us the
date this dream occurred: __________________.  Then tell us what time of day
you think you recalled it: __________________.  Then tell us where you were
when you recalled it: ___________________________________________.

Please describe the dream exactly and as fully as you remember it.  Your
report should contain, whenever possible: a description of the setting of the
dream, whether it was familiar to you or not; a description of the people,
their age, sex, and relationship to you; and any animals that appeared in the
dream.  If possible, describe your feelings during the dream and whether it
was pleasant or unpleasant.  Be sure to tell exactly what happened during the
dream to you and the other characters.  Continue your report on the other side
and on additional sheets if necessary.