Download Shidduch Connection Profile

PERSONAL INFORMATION
Name
_____________________________________
Hebrew Name _____________________________________
Street Address __________________________________
City ______________ State ____ Zip_______________
Date of Birth (Month/Day/Year) ____/____/____
Telephone:
Home (_____) _________________________
Work (_____) _________________________
Fax
(_____) _________________________
E-Mail Address _______________________________
Gender (Circle One): Male
Female
Height:_____________
EDUCATION AND OCCUPATION
1) Please circle your level of secular education:
High School
Attended College
Graduated College
Graduate School
2) Undergraduate Degree/Major________________________________________
3) Graduate Degree/Major_____________________________________________
4) Current Occupation________________________________________________
MARITAL INFORMATION
5) Marital Status (Circle One)
Never married
Divorced
Widowed
Other________
5a) If divorced, please give the name and phone number of the Rabbi who facilitated the Get:
5b) Name of Rabbi_____________________________
Phone Number_______________________
6) Do you have children (circle one)? Yes No
If yes, How many? _________ Age Ranges _____________
Do they live with you (circle one)?
Yes
No
Other(please explain)_______________________________
7) Women Only: Are you interested in marrying a Kohen?
Yes
No
(If you're not sure as to how to answer this question, please ask your
Rabbi or ask the interviewer before making a selection.)
JUDAIC BACKGROUND
1) Please describe your level of Judaic education (circle all that apply)
1a) Elementary:
Orthodox
Conservative
Reform
Other___________________
Reform
Other___________________
Reform
Other___________________
Day school or "Sunday" school
1b) High School: Orthodox
Conservative
Day school or "Sunday" school
1c) College:
Orthodox
Conservative
Day school or "Sunday" school
1d) Other (Yeshiva, courses or shiurim at shuls, schools, etc.)
____________________________________________________
2) Are you: Ashkenazi Sephardi
Other ________________________
3) Are you: Observant From Birth
4) Are you: Chassidish
Ba'al Tshuva
Modern Orthodox
Convert
Yeshivish
Conservative
Reform
Other__________________
5) If you're a Ba'al Tshuva, how long have you been completely observant
(Shabbos, Kashrus, etc.)? _______________
5a) How long has it been since you've started this process?
_______________________________________________
5b) Are you comfortable with level of observance currently changing (please explain)
_______________________________________________________________
_______________________________________________________________
6) Please describe your religious commitment and present level of observance.
________________________________________________________________
________________________________________________________________
7) Do you: Watch or Own TV? Yes
8) Do you: Go to Movies? Yes
Never
Never
Sometimes
Sometimes
9) Do you participate in mixed swimming? Yes
No
Sometimes
10) Do you participate in mixed dancing? Yes
No
Sometimes
11) Do you: Eat in non-kosher restaurants? Yes
Never
Sometimes
11a) If Yes or Sometimes, please circle all that apply:
Fish
Dairy
Salads
Drinks Other__________________
12) Women Only: Do you wear pants? Yes
Never
Sometimes
13) Women Only: When you are married, will you cover your hair?
_____________________________________________________________
_____________________________________________________________
14) Men Only: Are you a: Kohen Levi Yisrael
15) Men Only: Are you comfortable with your wife wearing pants?
Yes
Never
Sometimes
16) Men Only: When you are married, what are your plans for learning Torah?
________________________________________________________________
________________________________________________________________
17) Current Synagogue Affiliation:
________________________________________________________________
18) Name and Telephone Number of Rabbi:
________________________________________________________
HOBBIES AND PERSONAL CHARACTERISTICS
1) How do you spend your spare time (please circle all that apply)?
Learning
Reading
Sports
Socializing
Cultural Events
2) What do you spend most of your spare time doing?
____________________________________________________
3) Write three words that describe you:
a.__________________________
b.__________________________
c.__________________________
TV/Movies
4) Do you smoke?
Yes
No
Are you willing to date a smoker? Yes
No
5) Are you willing to travel to meet someone for a date?
Yes No
5a) If Yes, how far?__________________________
6) Are you willing to relocate if you met the right person? Yes
7) Is making Aliyah to Israel a priority for you? Yes
No
No
Maybe
Maybe
Feel free to provide any additional information about yourself that may be
helpful in finding a suitable match; use additional paper if necessary or
just at the bottom of the form.
TELL US ABOUT THE KIND OF PERSON YOU WOULD WISH TO MEET
1) Age range of the person you would like to meet?__________________________
2) Physical attributes (height, weight, etc.)
________________________________________________
3) Educational Background (circle minimum level):
High School
College
Graduate Degree
Does not matter
4) Jewish Education Background:
Yeshiva
5) Ashkenazi
Does not matter
Sephardi
Other_________________________________
Does not matter
Other_______________________________________________
6) Marital Status (circle all that apply):
Divorced
Widowed
Never Married
Does not matter
7) Will you date someone with children? Yes
No
________________________
8) Affiliation (circle all that apply):
Chassidish
Modern Orthodox
Yeshivish
Conservative
Reform
Other_________
9) Would you like the person you meet to be (circle all that apply):
Observant from birth
Ba'al Tshuva
Convert
Does not matter
10) Women Only: Is it important that your husband learn Torah regularly? ____
Please explain:
________________________________________________________________
________________________________________________________________
11) Men Only: Is it important that your wife cover her hair? ____
If so, how?
________________________________________________________________
________________________________________________________________
12) Use of spare time (circle all that apply)?
Learning
Reading
Sports
Socializing
Cultural Events
TV/Movies
13) Name three of the most important qualities you seek in a mate:
a._____________________
b._____________________
c._____________________
14) Should making Aliyah to Israel be a priority? Yes
No
Maybe
15) Feel free to provide any additional information about the type of
person you wish to meet that may be helpful in finding a suitable match.
Use additional paper if necessary or just at the bottom of the form.
PHOTO
Please include a recent photo of yourself.
REFERENCES
Please provide name, address, tel. number and relationship of two references, who are
not related to you. (Ref. #1 should be a Rabbi who knows you well.)
1) Name_________________________ 2) Name________________________________
Address__________________________
Address______________________________
City__________State____Zip________
City__________State____Zip___________
Phone___________________________
Phone___________________________
Email___________________________
Email___________________________
Relationship_______________________ Relationship_______________________
** Someone will contact you within several weeks after
receipt of this application to arrange an interview **
This agreement is entered into by the undersigned, who hereby makes
application to participate in the Matchmaking program sponsored by the Young
Israel of Brookline in Massachusetts and agrees to abide by its policies.
The Matchmaking Program is a service offered by the Young Israel of Brookline
to facilitate introductions between Jewish single adults. The information on
each profile is provided solely by each participant, and Young Israel of
Brookline assumes no responsibility for, and makes no representation
regarding the accuracy or reliability of such information. By making this
application, the undersigned (1) represents that the information provided by
the undersigned to Young Israel of Brookline for participation in the
Matchmaking Program is true and correct, and (2) assumes the full risk of,
and responsibility for, ascertaining the accuracy and reliability of any and
all information provided by other participants in the Matchmaking Program
with whom the undersigned may interact. It is understood that the undersigned
consents to having this profile sent to other shadchanim. Young Israel of
Brookline makes every effort to keep records confidential, but assumes no
responsibility if information is inadvertently given out.
Furthermore, the
Young Israel of Brookline and its agents reserve the right to accept as a
client any candidate for this program. Having given due consideration to the
above, the undersigned hereby releases, acquits, discharges, indemnifies, and
holds harmless the Young Israel of Brookline, their officers, directors,
agents, independent contractors, volunteers and employees from any and all
damages, illnesses (including the possible exposure to AIDS and other
infectious diseases), injuries, claims, demands and causes of action of
whatever nature and character (and all costs of defense and related thereto)
which may accrue to be asserted by the undersigned, any other participant in
the Matchmaking Program, or any person or entity claiming by, through, or on
behalf of the undersigned, or any other participant in the Matchmaking
program arising directly or indirectly out of the application or
participation by the undersigned.
Name (please print):_________________________________ Date:______________
Signature:________________________________________________________________
Please return to: Young Israel of Brookline - Shidduch Committee
62 Green Street, Brookline, MA 02446