Shadchan's Circle

questionnaire for new member
with medical issue(s)

Please note: This profile will be viewable by ONLY THOSE FEW shadchanim that deal specifically with medical issues.

 

Personal * Required information
Gender *:   Male     Female 
First Name*:  
Last Name*:  
if you do not feel comfortable using your real name, you may use a screenname by which we will refer to you. Please leave a real email address and/or phone number so that we can contact you.
Date of Birth*:  
Address
Street Address:  
Post Code:  
City/State:  
Country:*  
Contact
Telephone Number :*  
Cell Number :  
Fax Number :  
E-Mail Address :*  
Physical Information * Required information
Height :*   Weight :  
Style:  
Hair Colour :   Eye Colour :  
Lifestyle
My Marital Status:*   If divorced, ex-spouse:
Do you have children? *   No     Yes  If so, how many children?  
Mother's first and maiden name:*  
Father's first name:*
Name of shul affiliated with:
Are there siblings in the family? No  Yes  If there are siblings how many?
Family's machatonim if any...
Are you willing to relocate?   No     Yes 
Do you want to make Aliyah?   No     Yes 
What is your Native Language?*  
Profession:  
Job description:  
I plan on owning a TV:  
I plan on Going out to Movies:  
I plan on Watching Movies at Home:  
 
Education
Secular Education
Highest Education Level:*  
Name of Elementary School:  
Name of High shool:  
Name of College(s) or Universit(y)(ies):  
Studies:  
Jewish Education
Jewish Education:*
 
Did you study in Israel for (more than) a year? No  Yes
If yes, what is the name of the school:  
If applicable, Name of other Yeshivas or Seminaries:  
Languages Spoken
 English  Arabic  French  Japanese  Romanian
 Hebrew  Chinese  German  Persian/Farsi  Russian
 Yiddish  Czech  Hungarian  Polish  Spanish
   Dutch  Italian  Portuguese  Other
Religious Information

My current religious orientation:*   
If you have chosen Chassidish:  
      What Chassidus do you follow?
      Do you wear the "chassidishe levush" ? No  Yes
      Comments:
Are you a Baal Teshuva?*   No    Yes  If yes, for how long:
Are you a Cohen?* Are you eligible to marry a Cohen?*   No    Yes 
Ethnicity:*  
Family Religious Background:  
References
Please supply a reference that the Matchmaker can call. A reference is required by us before we will match you.
If possible, at least one reference should be from a Rabbi.
Reference 1
Title:  First Name:  *  Last Name:  *
Contact Phone#:  *  
My relationship to reference:  *
Reference 2
Title:  First Name:    Last Name:  
Contact Phone#:    
My relationship to reference:  
Personal Description
Describe yourself. This is (as everything else) strictly confidential.
This is the moment to tell us should you have any disabilities or other issues to be taken into account when we propose a shidduch. (Max 500 characters)
If you find the space given is not enough to adequately enter a description, please continue with the form and after submitting your profile to our website, login, scroll down to the personal description and you will have a link to upload a word document.

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Please describe or name your medical issue(s):

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What 3 character traits describe your personality best?
 Adventurous  Intelectual  Responsible Sensitive/nurturing  Spontaneous
 Artisitic  Kind  Romantic Sophisticated/worldy  Talkative
 Easygoing  Open minded  Self confident  Spiritual  Witty
 Friendly  Practical      
What are you looking for in a match? Please try to fill this carefully as it will help us to help you find a match.
Height From:  * To:  *
Age From:  * To:  *
Marital Status:  *
Religious orientation:  * OR  *
OR  *  
I would consider:  Baal Teshuva  Divorced(ee)  Widow(ed)
 
What are the 3 most important character traits you are looking for in a match?
 Adventurous  Intelectual  Responsible Sensitive/nurturing  Spontaneous
 Artisitic  Kind  Romantic Sophisticated/worldy  Talkative
 Easygoing  Open minded  Self confident  Spiritual  Witty
 Friendly  Practical      
Please choose a user name and password so that you can update your info.
Username:      Password:

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