Please copy the form below into your email or word document and forward to izzy@actcom.co.il

 

V’ahavta LeRayecha Kamocha

SINGLES QUESTIONNAIRE                                                                 B"H

 

 

Name:

Tel. #:

Cell #:

Email:

Age:

 

Reference 1: (Name & Tel. #)

Reference 2: (Name & Tel. #)

CONTACT PERSON who will act as a liaison for this single: (Name & Tel. #, email if available)

 

 

About the Single:

Grew up in:

Currently lives in:

Ashkenazi, Sephardi, Mixed, Other

Religious Status:

Mod. Orthodox, Orthodox, Baal Teshuva, Frume, Black Hat, Mesorati, Chiloni

 

Educational Level:

Educational Institutions Attended:

Yeshiva (Where/Years):

 

Occupation:

Approximate Date of Aliyah:

Army/Sherut Leumi:

 

Height:

Body Structure: Slim, Normal, A Little Chubby, Chubby

General Appearance:

Personality Type: (e.g. sense of humor, super bright, outgoing, shy, sensitive)

 

Special Talents/Interests:

 

Smoking, Non-Smoking

For Women: Skirt/Pants

Head Covering (that you would wear):

Family Situation: Israel/US/Other

Special Circumstances:

 

Dating age range requested:

Picture available (please email)

 

Additional Comments:

 

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V’ahavta L’Rayecha Kamocha

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