Thank you for your interest in being a candidate! We look forward to learning more about you! First Name Last Name Email Address Primary Phone Number Birthday What is the best method to contact you?Select….E-mailPhoneEither What’s the best time of day to reach you?Select….MorningsAfternoonsEvenings Where do you live? StateSelect….AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareD.C.FloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew MexicoNew JerseyNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon(AU) Australian Capital Territory(AU) New South Wales(AU) Victoria(AU) Queensland(AU) Northern Territory(AU) Western Australia(AU) South Australia(AU) Tasmania(AF) Gauteng(AF) Western Cape(AF) Eastern Cape(AF) Kwa-Zulu Natal(AF) North West(AF) Northern Cape(AF) Mpumulanga(AF) Free StateMy State is not listed(IN) Assam(IN) Andaman and Nicobar Islands(IN) Andhra Pradesh(IN) Arunachal Pradesh(IN) Bihar(IN) Chandigarh(IN) Chhattisgarh(IN) Delhi(IN) Daman and Diu(IN) Dadra and Nagar Haveli(IN) Goa(IN) Gujarat(IN) Haryana(IN) Himachal Pradesh(IN) Jammu and Kashmir(IN) Jharkhand(IN) Karnataka(IN) Kerala(IN) Lakshadweep(IN) Mizoram(IN) Madhya Pradesh(IN) Meghalaya(IN) Manipur(IN) Maharashtra(IN) Nagaland(IN) Odisha(IN) Puducherry(IN) Punjab(IN) Rajasthan(IN) Sikkim(IN) Tripura(IN) Tamil Nadu(IN) Uttarakhand(IN) Uttar Pradesh(IN) West Bengal Interested InSelect….MenWomen GenderSelect….MaleFemale Are you currently single?Select….YesNo Have you ever been married?Select….YesNo If yes, for how long? Do you have children?Select….Yes and they live with meYes and they live with me part timeYes and they don’t live with meNo If yes, how many and what ages are they? Do you want children?Select….YesNoUndecided Is your decision regarding children firm or flexible for the right partner? Would you welcome a partner’s children?Select….YesNoUndecided When was your last relationship, how long did it last and why did it end? What age range do you prefer to date? (Check all that apply) 20 – 24 25 – 29 30 – 34 35 – 39 40 – 44 45 – 49 50 – 54 55 – 59 60+ What are you looking for in a soulmate? Is race or religion an important factor in who you will date? What color are your eyes?Select….BrownBlueGreenHazel How tall are you? What is your hair color?Select….BlondeBrownRedBlackSalt & PepperGreyBaldOther What is your approximate weight? What makes you unique? What are you most proud of in your life? What are your political viewpoints? What is your occupation? Tell me about what you do. What is your idea of perfect happiness? Where did you grow up and what did most enjoy about that area? How would your friends and/or family describe you? Have you ever worked with a matchmaker/dating agency before?Select….YesNo If yes, please describe your experience. What has your experience been with online dating? On a scale of 1 – 10, how ready are you to begin a search for love? (With 1 being not at all, and 10 being ready right NOW!)Select….12345678910 Create your own Mini Bio! How would you best describe yourself in 3 sentences? Note: This portion may be shared with potential matches. How did you hear about LOVE by Design? This questionnaire is considered complete after sending 3 or more recent (within last 6 months – 1 year) photos (including full body and head shots) to Traci at firstname.lastname@example.org. If the Submit button doesn’t work, please look above and complete the required fields noted in red.