Moonshine Anarchy's blog: "bloggin blogger blog"

BASICS:

 

Name (last, first, middle, aliases): _____________________________

 

Age: ___

 

Hair Color: __________________

 

Eye Color: __________________

 

Height: __________

 

Weight: _________

 

Phone: ( ) ______ ___________

 

Email Address: _________________________________

 

Have two female acquaintances rate your looks, circling one number per
evaluator, and obtain their signatures:

 

1 2 3 4 5 6 7 8 9 10

X______________________

 

1 2 3 4 5 6 7 8 9 10

X______________________

 

 

PREVIOUS EXPERIENCE:

 

Number of previous relationships: ____

 

Number of previous serious relationships: ____

 

Virgin? (Circle one): Yes No Questioning

 

If not, by what margin?: ____

 

Describe most recent ex (Leave blank if not applicable):
_____________________

 

_______________________________________________________________________

 

Percentage of exes on good terms with (Leave blank if not applicable): ____%

 

 

INTELLECTUAL BACKGROUND:

 

Class Year: Freshman Sophomore Junior Senior

 

Highest level of education completed: _____________________

 

Major (if applicable): ____________________

 

Number of languages proficiently spoken or read: ______

 

Career (Or career plans): ________________________________________________

 

 

GENERAL:

 

Hours spent shopping in last six months: ____

 

Favorite movie: _________________________

 

Professed religious faith: _______________________

 

Describe your personality briefly: _________________________________________

 

________________________________________________________________________

 

________________________________________________________________________

 

Are you involved in sports?: Yes No Questioning

 

If so, which one(s)?: _____________________________________________________

 

________________________________________________________________________

 

Are you involved in a fraternity?: Yes No Questioning

 

If so, which one? Please briefly describe its
purpose:_________________________

 

_______________________________________________________________________

 

Describe any leadership positions you have held: ___________________________

 

_______________________________________________________________________

 

_______________________________________________________________________

 

 

REFERENCES:

 

Please attach two letters of reference, preferably one from an ex, and
provide contact information below (optional, but highly recommended):

 

Name: _________________________________________

 

Phone: ( ) ______ ___________

 

Email Address: _________________________________

 

 

Name: _________________________________________

 

Phone: ( ) ______ ___________

 

Email Address: _________________________________

 

 

SHORT ANSWERS:

 

Please answer two of the following questions in the space provided:

 

 

1. Where would you take me on a date, and what would we do?

 

 

 

 

2. In what ways do you show yourself a gentleman while on a date?

 

 

 

 

3. How might you make Valentine’s Day a memorable occasion?

 

 

 

 

 

_____________________________________________________________________________________________________

Thank you for your application! You will receive notification within 4-6
weeks, at which time an interview with a panel will be required