Questions

Academics
Military
Physical Features
Physical Aids
Facial Features
Family Information
Donor's Parents
Donor's Siblings
Father's Siblings
Mother's Siblings
Father's Parents
Mother's Parents

Personal Information

Talents:
Voice:Tenor
Instrument:
Years of experience:		Trumpet - 6 (in high school)
Other talents:
Years of experience		None
Favorite:
ColorGreen
FoodSteak and potatoes
MusicRock
AnimalDog
PetDog
CarCorvette
MovieRounders
Song"One" by Metallica
PlayN/A
Goals:
AcademicComplete a Surgical First Assistant program
Professional Become a Surgical First Assistant
PersonalStart a family
Religion:
Faith None
Denomination Atheist
Languages:
SpeakEnglish
ReadEnglish
WriteEnglish
Sports:
PlayHockey
WatchFootball, Hockey, Baseball
Siblings:
# Brothers0
# Sisters1
Are you a twin?
Identical or fraternal?		No
# of twins in your family0
# Identical sets0
# Fraternal sets0

Academics

Standard Test Score: provide score or denote N/A if not taken
SAT
on scale of		N/A
ACT
on scale of		N/A
GRE
on scale of		N/A
MCAT
on scale of		N/A
LSAT
on scale of		N/A
GMAT
on scale of		N/A
TOEFL
on scale of		N/A
Other
on scale of		N/A
High School
Question Response on scale of
GPA
on scale of 		3.34.0
College
Question Response on scale of
GPA
on scale of 		3.044.0
Graduate School
Question Response on scale of
GPA
on scale of 		N/A
Subjects Studied:
Major subjectsSurgical Technology
Minor subjectsN/A
Degrees
Bachelor'sN/A
Master'sN/A
DoctorateN/A
Other(s)AS/Surgical Technology
Awards & Activities
High schoolTrumpet
CollegeN/A
AcademicN/A
Professional Military
Political N/A
Personal Hockey, Fishing, Outdoor activities
Charitable N/A
OthersN/A

Military

Served in militaryYes
BranchAir Force
RankStaff Sergeant
Years of service6

Physical Features

HandsRight-Handed
FingersMedium
Sizes & Measurements
Neck (inches)15
Chest (inches)38
Inseam (inches)31
Waist (inches)32
Sleeve (inches)33.5
Wrist (inches)7
Hat size7.25
Shoe size9

Physical Aids

Eyes:
Vision Normal
GlassesNone
AstigmatismNo
Age started wearing glasses/contactsN/A
Laser surgery?No
Dental:
DeviceNone
ReasonN/A
Age range during useN/A
Other Physical Aids:
ListNone
Reason/causeN/A

Facial Features

Eyes:
Set
  • NarrowNarrow
  • AverageAverage
  • WideWide
Size
  • SmallSmall
  • AverageAverage
  • LargeLarge
Shape
  • AlmondAlmond
  • OvalOval
  • RoundRound
Color
  • Black
  • Blue
  • Green
  • Hazel
  • Brown
Shade
  • Light
  • Medium
  • Dark
Eyebrows:
Arch
  • Flat
  • Medium
  • High
Thickness
  • ThinThin
  • AverageAverage
  • ThickThick
Set
  • Narrow
  • Average
  • Wide
Nose:
Size
  • Small
  • Medium
  • Large
Shape
  • RoundRound
  • StraightStraight
  • WideWide
Width
  • Narrow
  • Average
  • Wide
Length
  • Short
  • Average
  • Long
Bridge
  • ConvexConvex
  • StraightStraight
  • ConcaveConcave
Nostril flare
  • Small
  • Average
  • Wide
Septum
  • Thin
  • Average
  • Thick
Cheekbones:
Set
  • Low
  • Average
  • High
Prominence
  • Slight
  • Medium
  • Strong
Mouth:
Size
  • SmallSmall
  • AverageAverage
  • LargeLarge
Lips
  • ThinThin
  • AverageAverage
  • FullFull
Turn
  • Downward
  • Straight
  • Upward
Teeth:
Size
  • AverageAverage
  • LargeLarge
  • SmallSmall
Set
  • Underbite
  • Even
  • Overbite
Condition
  • Poor
  • Fair
  • Good
Chin:
Shape
  • RoundRound
  • OvalOval
  • SquareSquare
Prominence
  • Slight
  • Average
  • Strong
Cleft
  • NoneNone
  • SlightSlight
  • StrongStrong
Ears:
Size
  • SmallSmall
  • AverageAverage
  • LargeLarge
Set
  • Low
  • Average
  • High
Angle
  • FlatFlat
  • AverageAverage
  • AcuteAcute
Lobe size
  • Small
  • Medium
  • Large
Lobe attachment
  • DetachedDetached
  • AttachedAttached
Hair:
Color at birth
  • Blond
  • Brown
  • Auburn
  • Red
  • Black
  • grey
Natural color in adulthood
  • Blond
  • Brown
  • Auburn
  • Red
  • Black
  • grey
Shade
  • Light
  • Medium
  • Dark
Type
  • Straight
  • Wavy
  • Curly
Fullness
  • Thin
  • Medium
  • Thick
Texture
  • Fine
  • Coarse
  • Medium
Skin:
Tone
  • Light
  • MedL
  • Med
  • MedDk
  • Dark
Tan ability
  • None
  • Slight
  • Medium
  • Easy
Condition
  • Oily
  • Medium
  • Combination
  • Dry
Hairline:
Forehead
  • Low
  • Average
  • High
Contour
  • Straight
  • Slight Curve
  • Widow Peak
Other Facial Features:
Moles
  • None
  • One
  • Several
Freckles
  • None
  • Several
  • Moderate
  • Numerous
Dimples
  • None
  • Slight
  • Medium
  • Deep
Adam's apple
  • Slight
  • Medium
  • Strong
Facial Hair
Thickness
  • Thin
  • Medium
  • Dense
Shade
  • Light
  • Medium
  • Dark

Family Information

Donor's Parents
Donor's Father Personal Information
OccupationDirector of Maintenance
Donor's Father Education:
LevelCollege
DegreeBachelor
SubjectAviation
Donor's Father Religion:
Faith Christian
Denomination Catholic
Primary ethnic origins:Scottish
Donor's Father Languages:
SpeakEnglish
ReadEnglish
WriteEnglish
Donor's Father Talents:
VoiceBaritone
Instrument
yrs experience		None
Other
yrs experience		None
Donor's Father Physical Information
Body
Age65
Height5'10"
Weight180 lbs.
HandsRight-Handed
Donor's Father Facial Features
Eyes:
Eye ColorBlue
Eye shadeMedium
Vision Normal
GlassesNone
AstigmatismNo
Age started wearing glasses/contacts
yrs		N/A
Hair:
Original hair color Red
If gray, age turned gray55
TypeStraight
Skin:
Skin ToneMed
Skin ConditionMedium
Other:
Chin cleftSlight
Ear lobeDetached
Facial DimplesMedium
Military
Served in MilitaryYes
BranchAir Force
RankSenior Airman
Years of service4
Donor's Mother Personal Information
Occupation Self-employed
Donor's Mother Education:
LevelHigh school
DegreeDiploma
SubjectGeneral Studies
Donor's Mother Religion:
Faith Christian
Denomination Catholic
Primary ethnic origins:German, English, Native American
Donor's Mother Languages:
SpeakEnglish
ReadEnglish
WriteEnglish
Donor's Mother Talents:
VoiceSoprano
Instrument
yrs experience		None
Other
yrs experience		None
Donor's Mother Physical Information
Body
Age59
Height5'6"
Weight130 lbs.
HandsRight-Handed
Facial Features
Eyes:
Eye ColorBlue
Eye shadeMedium
Vision Normal
GlassesNone
AstigmatismNo
Age started wearing glasses/contacts
yrs		N/A
Hair:
Original hair color Blond
If gray, age turned gray50
TypeStraight
Skin:
Skin ToneLight
Skin ConditionMedium
Other:
Chin cleftNone
Ear lobeDetached
Facial DimplesSlight
Military
Served in MilitaryNo
BranchN/A
RankN/A
Years of serviceN/A
Donor's Siblings
Donor's Sibling(s) (1-4)
Donor's Sibling #1
Full/Half siblingHalf
Sibling #1 Physical Information
Body
SexFemale
Age40
Height5'6"
Weight150 lbs.
HandsRight-Handed
Sibling #1 Personal Information
Occupation Physical Therapist
Education:
LevelCollege
DegreeAssociate
SubjectPhysical Therapy
Religion:
Faith Christian
Denomination Catholic
Languages:
SpeakEnglish
ReadEnglish
WriteEnglish
Talents:
VoiceAlto
Instrument
Years of experience		None
Other
Years of experience		None
Sibling #1 Children:
# Boys
Ages:		1 - 9
# Girls
Ages:		0
Sibling #1 Facial Features
Eyes:
Eye colorBlue
Eye shadeMedium
Vision Normal
GlassesNone
AstigmatismNo
Age started wearing glasses/contactsN/A
Hair:
Original hair color Blond
If gray, age turned grayN/A
TypeStraight
Skin:
Skin toneLight
Skin conditionMedium
Other:
Chin cleftNone
Ear lobeDetached
Facial dimplesSlight
Military
Served in militaryYes
BranchAir Force
RankSenior Airman
Years of service4
Father's Siblings
Father's Brothers
# of Brothers1
Ages of Brothers:61
Education levels for each:Bachelor's
Occupations for each:Nurse
Religions for each:Catholic
Father's Brothers' Total Children:
# Boys1
# GirlsN/A
Mother's Siblings
Mother's Sisters
# Sisters1
Ages of Sisters:58
Education levels for each:High school
Occupations for each:Maid Service
Religions for each:Baptist
Mother's Sisters' Total Children:
# Boys1
# Girls1
Father's Parents
Father's Father
Education
LevelHigh school
DegreeDiploma
SubjectGeneral Studies
Occupation:Postal Worker
Primary ethnic origins:Scottish
Siblings:
# Brothers1
# Sisters1
Other:
LanguagesEnglish
ReligionCatholic
Military
BranchAir Force
RankTechnical Sergeant
Service Yrs25
Father's Mother
Education
LevelHigh school
DegreeDiploma
SubjectGeneral Studies
Occupation:Homemaker
Primary ethnic origins:Scottish
Siblings:
# Brothers0
# Sisters1
Other:
LanguagesEnglish
ReligionCatholic
Military
BranchN/A
RankN/A
Service Yrs0
Mother's Parents
Mother's Father
Education
LevelCollege
DegreeBachelor's
SubjectAccounting
Occupation:Accountant
Primary ethnic origins:English, Native American
Siblings:
# Brothers1
# Sisters0
Other:
LanguagesEnglish
ReligionBaptist
Military
BranchN/A
RankN/A
Service Yrs0
Mother's Mother
Education
LevelHigh school
DegreeDiploma
SubjectGeneral Studies
Occupation:Dispatcher
Primary ethnic origins:German
Siblings:
# Brothers0
# Sisters1
Other:
LanguagesEnglish
ReligionBaptist
Military
BranchN/A
RankN/A
Service Yrs0