1. Name ___________________________________________________
    Date of Birth_______________________

2. Height _____________ Weight _________ IQ ______ GPA ________
    Soc. Sec. No. _______________________

3. Driver’s License No. _______________________
    Highest Boy Scout Rank Attained _______________________

4. Home Address ____________________________ Phone Number ______________________________

     Beeper Number ____________________________ Cell Phone ____________________________

     City ____________________________________________________ ST ___ ZIP ____________

5. Do you have one MALE and one FEMALE parent? ______

    If NO, explain: _______________________________________________________________________

    Number of years parents married _____________

6. Have you ever been arrested for anything? _________ If yes, explain: _________________________________

7. Do you own a van? ______ A truck with oversized tires? _______ A waterbed? _________

8. Do you have an ear ring, nose ring, belly button ring, or any ring on a part of your body other than your finger?_____
(NOTE: If the answer to any question in #6, #7, or #8 is YES, discontinue application and leave premises immediately)

9. In 50 words or less, what does LATE mean to you?                      ___________________________________________________

____________________________________________________________________________________________

10. In 50 words or less, what does DON’T TOUCH MY DAUGHTER mean to you? _____________________________

____________________________________________________________________________________________

11. In 50 words or less, what does ABSTINENCE mean to you? ___________________________________________

____________________________________________________________________________________________

12. Church you attend: _________________ How often? ____________________ How often really? _____________

13. When would be the best time to interview your father, mother, and pastor? _______________________________

14. Answer by filling in the blank. Please answer freely and honestly. All answers are confidential. I won’t tell anyone,   ever... I promise.

A. If I were shot, the last place on my body I would want to be wounded is __________________________________

B. A woman’s place is in the H___ ___ ___

C. The breadwinner in the family is _________________________________________________________________

D. The one thing I hope my girlfriend’s father never finds out about is ______________________________________

E. When I first meet a girl, the first thing I notice about her is _____________________________________________
(NOTE: If the answer to E begins with a B, a T, or an A, discontinue application and leave premises immediately,
keeping your head low and running in a serpentine fashion.)

15. What do you want to be IF you grow up? ________________________________________________________

I SWEAR THAT ALL INFORMATION SUPPLIED IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE UNDER PENALTY OF DEATH, DISMEMBERMENT, ELECTROCUTION, CHINESE WATER TORTURE, RED HOT POKERS UNDER MY ARMPITS, AND TELLING MY MOMMY.

signature: _____________________________________________________________

Thank you for your interest. Please allow four to six years for processing. You will be contacted in writing if you are approved. Please do not call or write. If your
application is rejected, you will be contacted by two gentlemen wearing white ties and carrying violin cases (you may want to watch your back).