The Survey

Please fill all answer boxes below.

Basic Information
Name
Age
Location
Birthdate
Sex
Race/Ethnicity
Religion

 

Physical Description
Height
Weight

 lbs

Hair Color
Eye Color
Embellishments

Tattoos Piercings Other things None

What's your best feature?

 

Lifestyle and Personality

What do you do for fun? What are some of your hobbies?

 

Your favorite:
 
 
Do you drink?
Do you smoke?
Occupation

Economic Status

 

 

What is your diet like?

salads
sweets
home cooked goodness

Whats your highest level of education completed?
What is your political stance?
Please check the box that best describes you.

I am:  
ambitious
very
moderately
not
intelligent
very
moderately
not
forgetful
very
moderately
not
outgoing
very
moderately
not
energetic
very
moderately
not
sensitive
very
moderately
not
loyal
very
moderately
not
funny
very
moderately
not
happy
very
moderately
not
predictable
very
moderately
not
optimistic
very
moderately
not
aggressive
very
moderately
not
usually stressed
very
moderately
not
modest
very
moderately
not
stubborn
very
moderately
not
social
very
moderately
not
emotional
very
moderately
not
in need of being in control
very
moderately
not
an activist
very
moderately
not
a romantic
very
moderately
not
catty, or petty
very
moderately
not
unable to commit
very
moderately
not
inventive
very
moderately
not
organized
very
moderately
not
   

 
Do you currently have a significant other?

 yes
no		  
Have you ever signed up on an internet dating site?
Please list 3 names of the most important people in your life
List 3 things you have done that you are proud of. These could be things like traveling to another country, learning a new language, or throwing out something that wasn't yours.

What is one of the "weirdest" things about you? It could be a unique talent, a quirk you have, a strange habit, etc.

Pet peeves (things that really bother you)

What kind of people or what specific person do you like?

 
Dislike?
What kind of women or what specific woman do you like?

Dislike?

What kind of men or what specific man do you like?

Dislike?

Would you like some tea?
 
Finished?