1. The last four digits of your cellphone number: ___________
2. The last four digits of your Social Security number: __________
3. What was your gender at birth? _______ Male ______ Female
4. Are you heterosexually, instead of homosexually, oriented? ______ Yes ______ No
5. What is your birth year? ________
6. What is your ethnicity: _________ Caucasian (White) ________ Negroid ________ Asian _______ Combo
7. What is your height: ________ less than 5' _______ 5' to 5'9" _______ over 5'9" ______ well over 5'9"
8. What is your weight? __ under 100 lbs __ 100 to 135 lbs __ 136 to 155lbs __ 156 to 175 lbs __ over 175 lbs ____ well over 230 lbs
9. What is your eye color? ____ Blue or Blue/Grey ____ Brown _____ Dark Brown _____ Green/Yellow/Grey
10. What is your religion? _______ Non-Baptist Liturgical Protestant _____ Baptist Protestant ________ Non-Baptist Non-Liturgical Protestant ________ Catholic _______ Conservative or Orthodox Jew ________ Mormon _______ Jehovah's Witness _________ Islamic _______ Buddhist ________ Hindu ________ Russian Orthodox _______ Greek Orthodox ________ Other (Specify: _____________________)
11. How often do you attend church, synagogue, or temple? _______ At least once a week ________ Several times a year _______ Twice a year, or very seldom ________ I am a totally-surrendered-to-Christ Christian who believes the redemptive gospel of Jesus as Lord and who must perfectly obey all the moral Law of God 24/7
12. Where do you usually live? _______ At home alone _______ At home with parents _______ In an apartment alone _______ In an apartment with roommate(s) ________in a college dorm, fraternity, or sorority _______ sometimes in storage unit or vehicle
13. Do you rent living quarters wherein you reside? ______ Yes ______ No
14. Do you own your living quarters wherein you reside? _______ Yes _______ No
15. What vehicle(s) do you own and mostly use? ______ Car(s) _______ Other vehicle(s)
16. Do you have a Driver's License? ___ Yes ___ No If so, for what State? (Specify: ______________________)
17. Do you have, or have you had, a Police Record for Gross Misdemeanor or Felony? _______ Yes ______ No
18. Have you ever been at least temporarily imprisoned for court conviction? _____ No ______ Yes
19. If you served in the Military, in which Branch: (Specify: ________________________)
20. What outstanding loans do you owe? ____ Vehicle loan ____ Mortgage ____ Student Loan ____ Other Loan(s)
21. Do you have and use a debit or credit card? ______ Yes _______ No
22. How much do you presently have saved? ______ under $1000 _____ over $1000 _______ well over $1000
23. Are you currently enrolled in an educational institution? _______ Yes _______ No
24. Are you a Vo-Tech or College Graduate? ______ Yes ______ No
25. Are you now employed? ____ Part-time ____ Full-time ____ Laid-off ____ Collecting SS or Unemployment
26. General occupation you get paid for? (Specify: __________________________________)
27. Main avocation(s) or hobby you are occupied with? (Specify: _________________________)
28. Have you ever smoked cigarettes or cigars? ________ In the past ________ Occasionally _______ Never
29. Have you ever drank alcholic beverages? _______ In the past _______ Occasionally ________ Never
30. Have you ever been drunk so as to see hallucinations, stagger or vomit? _______ No ______ Yes
31. Type of dancing you would do? ______ Slow waltzing only with same opposite-gender partner _______ Square Dancing with different opposite-gender partners ________ Modern wild-movement dancing ________Square dancing with same-gender partners
32. What Bible translations do you prefer? ________ KJV mainly _______ RSV, NASB, ESV _______ other Protestant Bible translations _______ other religious texts
33. Do you have any tattoos or piercings on you? ____ None ___ On arm ___ Elsewhere on body
34. You use fingernail polish? _______ Never _______ Have in the past
35. You use toenail polish? ________ Never _______ Have in the past
36. You use perfume? _________Never _______ Am allergic to it ________ Have in the past
37. You use lipstick or eyeshadow? _______ Never ______ Have in the past
38. Is you crotch hair now shaved? _______ No ________ Yes
39. Wear contacts or glasses for nearsightedness? _______ No _______ Yes
40. If you have longer-than-mouth-level hair, how do you modestly display it when in public? _______ In an up-do ______ tied into a back-of-head ponytail
41. When in public during warm weather, do you consistently wear long or somewhat-short-sleeved garments? ______ Yes _____No
42. When in public during warm weather, do you consistently wear full-length pants, slacks, or trousers? ______ Yes _____ No
43. When in public during warm weather, do you consistently wear socks with whatever type of shoes? ____ Yes _____No
44. Do you sometimes utter vulgar four-letter words? _____ No ______ Yes
45. Do you sometimes utter God's name profanity? ______ No _____Yes
46. What major or minor surgical operations have you had? ________________ Major ______________ Minor ___None
47. Are you crippled in any way? ____Yes ___ No If so, how? (Specify:_____________________________________)
48. Ever been administered chemotherapy or radiation for cancer? ______ No _______ Yes
49. Do you have asthma, allergies, convulsions or tremors? __ No __ Yes If so, which? (Specify: _____________
50. Ever been vaccinated but have no incurable or terminable diseases? _______ Yes _____ No
51. Ever had any broken bones? _____Yes _____No
52. Has your residence or vehicle ever been vandalized? ______ Yes _______ No
53. Do you tolerate those who advocate committing abortion homicide? ______ No ______ Yes
54. Do you tolerate those who advocate calling abortion a "right?" _____No ______ Yes
55. Do you have any friends (not acquaintances) who tolerate those claiming to be homogay? ____ No ____ Yes
56. Do you believe in evolution instead of Divine and Biblical Creationism? ______ No ______ Yes
57. Do you support the State of Israel? _______ Yes ______No
58. Do you advocate Israel giving away their land to anti-Zionist "palestinians?" ______ No ______ Yes
59. Would you shake hands for greeting your opposite-gender partner on a first date? ______ No ______ Yes
60. Would you hold hands with your opposite-gender partner on a first date? _______ No _______ Yes
61. Would you give a cheek kiss to your opposite-gender partner on a first date? ______ No ______ Yes
62. Would you give a lips-on-lips kiss to your opposite-gender partner on a first date? _____ No _____ Yes
63. Would you briefly hug your opposite-gender partner on a first date? ______ No ______ Yes
64. Would you do extended hugging with your opposite-gender partner on a first date? _____ No ______ Yes
65. Would you fondle the clothes of and on your opposite-gender partner on a first date? ____ No ____ Yes
66. Type(s) of physical activities you like: ______ Tennis ______ Walking ______ Jogging ______ Bicycling ______ Bowling _______ Golf _______ Swimming _______ Wading _______ Swinging on a Swing ______ Trampolining ______ Skateboarding _____ Gymnastics _______ Ice Skating _______ Downhill Skiing ______ Hockey _______ Basketball _______ Frisbee Throwing ______ Volleyball _______ Football ______ Soccer _______ Badminton _______ Croquet ________ Motorboating _______ Sailing ______ Attending Concerts _______ Attending Church Together ______ Attending Fairs or Conferences
67. You, not your date, pay for vehicle fuel? _____ Yes _____ No _______ Both pay
68. You, not your date, pay for movie tickets or out-of-state motel costs? ______ Yes _______ No ________ Both pay
69. You, not your date, pay for lunch or dinner out food costs? ______ Yes ______ No _______ Both pay
70. Religious-Text Devotional Reading and Short Prayer is advisable to do on a first date? ______ Yes _______ No