Name *

Complete Home Address (City, State, Zip Code) *

Date of Birth *

Cell Phone *

Where did you spend most of your childhood? *

Age *

What age range would you prefer to date? *

Height *

Describe your Religious Status: such as Yeshivish, Chabad, Modern Orthodox, Conservadox, etc. *

If divorced: who gave you your get? And are you civilly divorced?

CHILDREN: Do have children? Ages? Do you want to have children?

How do you feel about marrying someone divorced? Please explain. *

Would you marry someone with children? *

Women- do you want to cover your hair?

Men- do you want a woman who covers her hair?

Where did you go to school? *

Degrees Received *

Occupation, pertinent past occupations *

What do you like about your current occupation? *

On a scale of 1 to 10, how much do you want to get married? *

On a scale of 1 to 10, how motivated are you to do what it takes to marry within 6-18 months? *

Name 5 things you are thankful for and WHY: (Don't forget the the WHY!) *

Name 5 things that give you pleasure/make you happy: *

Name 3 things that annoy you: *

Ten adjectives that describe you *

What are you core values? *

What are the 5 core values you need in a spouse? *

What are your deal breakers? *

Personal Description: Who are you? Don’t be shy! This is a chance to share yourself with potential spouses. (Include GOALS and INTERESTS) This is the place that a paragraph would be helpful. *

Looking For: What kind of person do you want to marry? Write what’s necessary for you to connect with your prospective life partner. This is another place where a paragraph would be helpful. Picture your future spouse and describe him/her. *

Shul/Rabbi’s name and phone # *

Share a little bit about your parents and siblings and your relationship with them. *

Willing to relocate? *

Willing to date long distance? *

Aliyah? *

Do you have a mental or physical handicap or challenge? (This information will remain confidential and will not be shared without your permission.) *

ON A SCALE OF 1 TO 10, HOW IMPORTANT IS LOOKS? DO YOU HAVE A “LOOK” THAT YOU ARE SET ON? *

WHAT IS YOUR CURRENT PRACTICE OF RELIGIOUS OBSERVANCE? WHAT LEVEL DO YOU NEED IN YOUR FUTURE SPOUSE? *

DO YOU TAKE CARE OF YOUR HEALTH? HOW? *

WHAT HAVE YOU LEARNED ABOUT MARRIAGE THROUGH YOUR OWN FAMILY SITUATION? *

WHAT MAKES YOU UNIQUE? WHAT GIFTS/TALENTS HAS HASHEM BLESSED YOU WITH THAT YOU MAKE YOU SPECIAL? (don’t be modest here!) *

WHAT WILL YOU BRING TO YOUR SPOUSE/MARRIAGE? IN WHAT WAYS MIGHT YOU BE A GIVER? *

HOW WOULD YOUR FRIENDS DESCRIBE YOUR PERSONALITY? *

WHAT DO YOU THINK HAS HELD YOU BACK FROM FINDING THE RIGHT PERSON TO MARRY? *

WHAT DO YOU FEEL IS YOUR PURPOSE IN THIS WORLD? *

WHAT KIND OF JEWISH HOME TO YOU ENVISION CREATING? *

WHAT DOES YOUR JUDAISM MEAN TO YOU AND HOW DO YOU EXPRESS IT?

WHAT DOES YOUR MARRIED IDEAL SHABBOS EXPERIENCE LOOK LIKE: *

Anything else you wish to share? *

Would you like to have a One on One Zoom Interview with Matchmaker Laurie? *