An Examined Life

an examined life

HOW TO APPLY:

Name:

Age:

Legal name as it appears on your state-issued i.d.: :

Hometown city and state:

Current Street Address:

City:

State:

Zip Code:

Cell Phone:

Alternate Phone:

Email: *

Facebook/Myspace i.d./Blog URL/etc.:

Emergency Contact Name:

Emergency Contact Phone:

Current Place of Employment:

Job Title:

Are you employed full time? :

What is your current relationship status? :

Do you have any children? (If YES, please list how many and their ages):

Have you ever appeared on television? (If YES please list project title, network and date of airing):

How did you hear about this opportunity? :

What is your highest level of education and what did you study? :

List all memberships and organizations you belong to (both past and present) :

Describe your personality, both best and worst qualities:

What are you passionate about? :

If single, for how long? :

Describe your last relationship and why/how it ended:

Describe your current dating life/sex life (why it’s great or awful) :

Describe the man of your dreams (personality and physical traits):

Describe your dream / perfect date (living or dead, fictional or real):

Describe the type of guy you would NEVER go for. Why? :

Where do you see yourself in 5 years? :

Who are your heros? (non-family members) :

What is your favorite thing in the world? :

If people (or you, yourself) have ever described you as “different” or “interesting” or “weird”, tell us why:

Do you have any activities you love participating in? :

What are your hobbies? :

Do you have any interesting collections? :

Describe a typical night out or in that you consider fun! :

What angers you more than ANYTHING? :

If you could change anything about yourself, what would it be? :

Any additional information you want to add? :

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