This is a Preliminary Survey designed to help you provide compatibility characteristics concerning yourself and the person you’d like to meet.  All information that you have provided will be held in the strictest confidence.

 

What is your marital status?	Please select from list Never Married Separated Divorced Widowed
Are you new to the area?	Yes No
What is your highest level of education?	High School Some College College Graduate Master’s Degree Ph. D
What’s your current occupation?
Your Income:	Under $15,000 $15,000 to $25,000 $25,000 to $35,000 $35,000 to $50,000 $50,000+
What are your relationship goals?	Casual Dating Long-Term Relationship Marriage
How long have you considered finding an alternative way of meeting people?
How did you hear about us?	Cable TV KCOL-AM KPAW-FM KSME-FM KTTR-FM KUAD-FM
What encouraged you to complete this questionnaire?

 
 

I prefer to date people from the age of	to    or It doesn’t matter
I would date someone with children	Yes No
I prefer to meet someone who has…	High School Some College College Graduate Master’s Degree Ph. D
I would date someone who smokes	Yes No It Doesn’t Matter
I wish someone shared my interest in…	Sports Music Outdoors Theater Food Other
I like people between	feet inches and feet inches  or It doesn’t matter
Things that attract me to someone of the opposite sex are

 

First Name
Last Name
Age
Male   Female
Today's Date
Home telephone
Work telephone
Address
City
State
Zip
Typical Work Hours
What is the best time to reach you?