LOOKING FOR RIGHT SHIDUCH?

DATING WHICH LEADS TO MARRIAGE

QUESTIONNAIRE FORM

Please fill in the following Questionnaire, E-mail or mail it back, along with the registration fee of $60 and two photographs. If you live in the metropolitan New York area, it is best to make an appointment for a personal interview. We have 3 interview sites: Manhattan (upper West side), Brooklyn (Borough Park) and Mapplewood, NJ. If you currently are too far to permit a personal interview, we will have a telephone interview with you and will start introducing you to suitable candidates. Please give us feedback and keep us posted through E-mail, phone or fax.

LAST NAME

FIRST NAME
English	Hebrew

HOME ADDRESS

Email Address

BUSINESS
Name	Address

TELEPHONE
Home	Office

OCCUPATION:

DATE OF BIRTH:

AGE:
HEIGHT:
WEIGHT:

MARITAL STATUS
Single Divorced Widowed

CHILDREN (gender and age):

JEWISH STATUS (born Jewish, convert):

If convert, please give details about conversion:

FOR MEN: Kohen Levi Yisroel

PARENTS' NAMES
	Father	Mother
English
Hebrew

PARENTS' ADDRESS: PHONE :

EDUCATIONAL BACKGROUND:

SYNAGOGUE AFFILIATION:

BRIEFLY DESCRIBE THE LEVEL AND TYPE OF YOUR JEWISH COMMITMENT

LIST AT LEAST TWO PERSONAL REFERENCES
Name	Address	Telephone

WHAT STRONG POINTS ARE YOU LOOKING FOR IN A POTENTIAL SPOUSE

WRITE A PARAGRAPH DESCRIBING YOUR PERSONALITY

WHAT ARE SOME OF YOUR INTERESTS

(optional)
PLEASE WRITE A BRIEF ESSAY (200 WORDS OR MORE) ON ONE OF THESE TOPICS:

GIVE'N'TAKE OF MARRIAGE or TEAMWORK
THE WAY I ENVISION MY FUTURE HOME AND FAMILY
MORAL ETHICS IN A MODERN WORLD
THE PLACE JUDAISM OCCUPIES IN MY LIFE
MY LIFE ASPIRATIONS AND GOALS
KIND OF GLASSES THROUGH WHICH I SEE THE WORLD AROUND ME
HOW I (think I will) RELATE TO KIDS

WHAT IS THE MAXIMUM TRAVEL TIME YOU ARE WILLING TO INVEST IN A DATE?

ARE YOU WILLING TO RELOCATE IF YOU MEET THE RIGHT ONE?
YesNo

Likrat Shiduch will, with G-d's help, utilize its extensive resources and make every effort to introduce to candidates deemed suitable for marriage. There are no guarantees and the registration fee is non-refundable. Furthermore, upon marrying someone introduced by Likrat Shiduch agrees to pay Likrat Shiduch an additional $1000 (besides another $1000
payable by spouse).

LIKRAT SHIDUCH Matchmaking Service
5 Nelson Pl
MAPLEWOOD NJ 07040
E-mail: lebovic@Juno.com
Phone 973-849-6418