Name ________________________Date__________

E-mail ______________________________________

Phone ________________Pager/Cell_____________

City________________________________________

DOB___/___/____ Race ____Height _____Wt _____

Divorced ____ Never Married _____ Widowed _____

Religion _____________________________________

Education ___________________________________

Political affiliation? _____________________________

Pets _______________________________________

Career at present  ____________________________

Hours per week ________Job Title_______________

Love job? ________ Travel required? ____________

High stress? Why? ____________________________

Career goals ________________________________

Career at past ______________________________

Hobbies ____________________________________

Spectator Sports _____________________________

Food preferences_____________________________

Social groups I belong to   _____________________

My birth order  ______________________________

How many siblings______ Brothers_____ Sisters____

Want Children? _______ Have Children? __________

How Many? _______ How Old? _________________

Morning or evening person _____________________

Own or rent? ________________________________

What type of home? __________________________

  Times available for dates __________________________

Goal of a future relationship: Marriage  _____________

Partnership  ___________ Casual dating ____________

My Personality Type (Mark Primary and Backup):

Expressive____________ Driver ___________________

Analytical_____________ Amiable _________________

My Best Habits

My Worst Habits

What I do for physical fitness or sports

What I do for personal growth

Things I love to do besides work

My Character

My Personal Assets

My Non-negotiable List

My Preferences

Who I Am!

My Appearance                

My Physical Health

My Personal Skills

My Career-Current and Future Goals

My Spiritual Beliefs

My Passions in Life

My Children- Present and/or Desired

My Picture