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Questions
Personal Information
Talents:
Voice: | Bass |
Instrument: Years of experience: | Guitar - 10 |
Other talents: Years of experience | Juggling - 12 |
Favorite:
Color | Red |
Food | Chipotle salmon roll |
Music | College rock |
Animal | Penguin |
Pet | Cat |
Car | Mustang |
Movie | American Beauty |
Song | "Chasing Cars" from Snow Patrol |
Play | Death of a Salesman |
Goals:
Academic | Medical Doctorate |
Professional | Medical Doctor |
Personal | Live to work and not the other way around |
Religion:
Faith | Christian |
Denomination | Lutheran |
Languages:
Speak | English |
Read | English |
Write | English |
Sports:
Play | Football, Softball |
Watch | Football |
Siblings:
# Brothers | 3 |
# Sisters | 0 |
Are you a twin? Identical or fraternal? | No |
# of twins in your family | 0 |
# Identical sets | 0 |
# Fraternal sets | 0 |
Academics
Standard Test Score: provide score or denote N/A if not taken
SAT on scale of | 1250 - out of 1600 |
ACT on scale of | 31 - out of 36 |
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 | ASVAB - 98 |
High School
Question | Response | on scale of |
GPA on scale of | 4.2 | 4.0 |
College
Question | Response | on scale of |
GPA on scale of | 2.6 | 4.0 |
Graduate School
Question | Response | on scale of |
GPA on scale of | N/A |
Subjects Studied:
Major subjects | Psychology |
Minor subjects | Biology and Theatre |
Degrees
Bachelor's | Pursuing BA/Psychology |
Master's | N/A |
Doctorate | N/A |
Other(s) | N/A |
Awards & Activities
High school | Honors graduate, Student council, Letter award in multiple sports, Drama club |
College | Fraternity |
Academic | Pre-med club |
Professional | Emergency Medical Technician |
Political | N/A |
Personal | Boy Scouts of America Eagle Scout |
Charitable | N/A |
Others | N/A |
Military
Served in military | Yes |
Branch | Army National Guard |
Rank | Staff Sergeant |
Years of service | 5 |
Physical Features
Hands | Right-Handed |
Fingers | Medium |
Sizes & Measurements
Neck (inches) | 17 |
Chest (inches) | 44 |
Inseam (inches) | 31 |
Waist (inches) | 36 |
Sleeve (inches) | 29 |
Wrist (inches) | 6 |
Hat size | 7.5 |
Shoe size | 12 |
Physical Aids
Eyes:
Vision | Normal |
Glasses | None |
Astigmatism | No |
Age started wearing glasses/contacts | 0 |
Laser surgery? | No |
Dental:
Device | Braces |
Reason | Cosmetic |
Age range during use | 12-14 |
Other Physical Aids:
List | None |
Reason/cause | N/A |
Facial Features
Eyes:
Set |
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Size |
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Shape |
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Color |
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Shade |
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Eyebrows:
Arch |
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Thickness |
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Set |
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Nose:
Size |
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Shape |
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Width |
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Length |
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Bridge |
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Nostril flare |
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Septum |
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Cheekbones:
Set |
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Prominence |
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Mouth:
Size |
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Lips |
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Turn |
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Teeth:
Size |
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Set |
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Condition |
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Chin:
Shape |
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Prominence |
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Cleft |
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Ears:
Size |
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Set |
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Angle |
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Lobe size |
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Lobe attachment |
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Hair:
Color at birth |
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Natural color in adulthood |
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Shade |
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Type |
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Fullness |
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Texture |
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Skin:
Tone |
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Tan ability |
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Condition |
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Hairline:
Forehead |
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Contour |
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Other Facial Features:
Moles |
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Freckles |
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Dimples |
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Adam's apple |
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Facial Hair
Thickness |
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Shade |
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Family Information
Donor's Parents
Donor's Father Personal Information
Occupation | Technician |
Donor's Father Education:
Level | Trade school |
Degree | Associate |
Subject | Electronics |
Donor's Father Religion:
Faith | Christian |
Denomination | Catholic |
Primary ethnic origins: | Swedish |
Donor's Father Languages:
Speak | English |
Read | English |
Write | English |
Donor's Father Talents:
Voice | Baritone |
Instrument yrs experience | None |
Other yrs experience | None |
Donor's Father Physical Information
Body
Age | 55 |
Height | 5'11" |
Weight | 190 lbs. |
Hands | Right-Handed |
Donor's Father Facial Features
Eyes:
Eye Color | Brown |
Eye shade | Medium |
Vision | Normal |
Glasses | None |
Astigmatism | No |
Age started wearing glasses/contacts yrs | 0 |
Hair:
Original hair color | Brown |
If gray, age turned gray | N/A |
Type | Straight |
Skin:
Skin Tone | Light |
Skin Condition | Dry |
Other:
Chin cleft | Slight |
Ear lobe | Attached |
Facial Dimples | None |
Military
Served in Military | No |
Branch | N/A |
Rank | N/A |
Years of service | 0 |
Donor's Mother Personal Information
Occupation | Technician |
Donor's Mother Education:
Level | Trade school |
Degree | Associate |
Subject | Electronics |
Donor's Mother Religion:
Faith | Christian |
Denomination | Lutheran |
Primary ethnic origins: | Swedish |
Donor's Mother Languages:
Speak | English |
Read | English |
Write | English |
Donor's Mother Talents:
Voice | Alto |
Instrument yrs experience | None |
Other yrs experience | None |
Donor's Mother Physical Information
Body
Age | 47 |
Height | 5'4" |
Weight | 230 lbs. |
Hands | Right-Handed |
Facial Features
Eyes:
Eye Color | Brown |
Eye shade | Dark |
Vision | Normal |
Glasses | None |
Astigmatism | No |
Age started wearing glasses/contacts yrs | 0 |
Hair:
Original hair color | Brown |
If gray, age turned gray | N/A |
Type | Straight |
Skin:
Skin Tone | Light |
Skin Condition | Oily |
Other:
Chin cleft | Medium |
Ear lobe | Attached |
Facial Dimples | None |
Military
Served in Military | No |
Branch | N/A |
Rank | N/A |
Years of service | 0 |
Donor's Siblings
Donor's Sibling(s) (1-4)
Donor's Sibling #1
Full/Half sibling | Full |
Sibling #1 Physical Information
Body
Sex | Male |
Age | 23 |
Height | 6'4" |
Weight | 195 lbs. |
Hands | Right-Handed |
Sibling #1 Personal Information
Occupation | Personal Care Attendant |
Education:
Level | College |
Degree | Pursuing |
Subject | Sociology |
Religion:
Faith | Christian |
Denomination | Lutheran |
Languages:
Speak | English, Spanish |
Read | English, Spanish |
Write | English, Spanish |
Talents:
Voice | Baritone |
Instrument Years of experience | Guitar, Drums - 14, 14 |
Other Years of experience | None |
Sibling #1 Children:
# Boys Ages: | 0 |
# Girls Ages: | 0 |
Sibling #1 Facial Features
Eyes:
Eye color | Green |
Eye shade | Light |
Vision | Normal |
Glasses | None |
Astigmatism | No |
Age started wearing glasses/contacts | 0 |
Hair:
Original hair color | Brown |
If gray, age turned gray | N/A |
Type | Straight |
Skin:
Skin tone | Light |
Skin condition | Medium |
Other:
Chin cleft | Medium |
Ear lobe | Attached |
Facial dimples | None |
Military
Served in military | No |
Branch | N/A |
Rank | N/A |
Years of service | 0 |
Donor's Sibling #2
Full/Half sibling | Full |
Sibling #2 Physical Information
Body
Sex | Male |
Age | 21 |
Height | 6'2" |
Weight | 190 lbs. |
Hands | Right-Handed |
Sibling #2 Personal Information
Occupation | Student |
Education:
Level | Some college |
Degree | Pursuing |
Subject | General Studies |
Religion:
Faith | None |
Denomination | None |
Languages:
Speak | English |
Read | English |
Write | English |
Talents:
Voice | Baritone |
Instrument Years of experience | Bass guitar - 10 |
Other Years of experience | None |
Sibling #2 Children:
# Boys Ages: | 0 |
# Girls Ages: | 0 |
Sibling #2 Facial Features
Eyes:
Eye color | Brown |
Eye shade | Medium |
Vision | Normal |
Glasses | None |
Astigmatism | No |
Age started wearing glasses/contacts | 0 |
Hair:
Original hair color | Brown |
If gray, age turned gray | N/A |
Type | Curly |
Skin:
Skin tone | Light |
Skin condition | Medium |
Other:
Chin cleft | Slight |
Ear lobe | Attached |
Facial dimples | Slight |
Military
Served in military | No |
Branch | N/A |
Rank | N/A |
Years of service | 0 |
Donor's Sibling #3
Full/Half sibling | Full |
Sibling #3 Physical Information
Body
Sex | Male |
Age | 18 |
Height | 5'10" |
Weight | 190 lbs. |
Hands | Right-Handed |
Sibling #3 Personal Information
Occupation | Student |
Education:
Level | High school |
Degree | Diploma |
Subject | General Studies |
Religion:
Faith | None |
Denomination | None |
Languages:
Speak | English |
Read | English |
Write | English |
Talents:
Voice | Baritone |
Instrument Years of experience | Guitar - 7 |
Other Years of experience | None |
Sibling #3 Children:
# Boys Ages: | 0 |
# Girls Ages: | 0 |
Sibling #3 Facial Features
Eyes:
Eye color | Brown |
Eye shade | Medium |
Vision | Normal |
Glasses | None |
Astigmatism | No |
Age started wearing glasses/contacts | 0 |
Hair:
Original hair color | Brown |
If gray, age turned gray | N/A |
Type | Straight |
Skin:
Skin tone | Light |
Skin condition | Combination |
Other:
Chin cleft | Medium |
Ear lobe | Attached |
Facial dimples | Deep |
Military
Served in military | No |
Branch | N/A |
Rank | N/A |
Years of service | 0 |
Father's Siblings
Father's Brothers
# of Brothers | 1 |
Ages of Brothers: | 66 |
Education levels for each: | Technical college |
Occupations for each: | Technical Assembly |
Religions for each: | Catholic |
Father's Brothers' Total Children:
# Boys | 1 |
# Girls | 0 |
Father's Sisters
# of Sisters | 1 |
Ages of Sisters: | 62 |
Education levels for each: | High school |
Occupations for each: | Teacher |
Religions for each: | Catholic |
Father's Sisters' Total Children:
# Boys | 0 |
# Girls | 3 |
Mother's Siblings
Mother's Brothers
# Brothers | 3 |
Ages of Brothers: | 52, 50, 45 |
Education levels for each: | All Technical college |
Occupations for each: | All Technicians |
Religions for each: | All Lutheran |
Mother's Brothers' Total Children:
# Boys | 2 |
# Girls | 2 |
Mother's Sisters
# Sisters | 1 |
Ages of Sisters: | 44 |
Education levels for each: | Bachelor's |
Occupations for each: | Health care |
Religions for each: | Lutheran |
Mother's Sisters' Total Children:
# Boys | 2 |
# Girls | 1 |
Father's Parents
Father's Father
Education
Level | High school |
Degree | Diploma |
Subject | General Studies |
Occupation: | Technician |
Primary ethnic origins: | Swedish |
Siblings:
# Brothers | 2 |
# Sisters | 1 |
Other:
Languages | English |
Religion | Catholic |
Military
Branch | Marine Corps |
Rank | Lance Corporal |
Service Yrs | 5 |
Father's Mother
Education
Level | High school |
Degree | Diploma |
Subject | General Studies |
Occupation: | Homemaker |
Primary ethnic origins: | Swedish |
Siblings:
# Brothers | 0 |
# Sisters | 0 |
Other:
Languages | English |
Religion | Catholic |
Military
Branch | None |
Rank | N/A |
Service Yrs | 0 |
Mother's Parents
Mother's Father
Education
Level | Some college |
Degree | Not completed |
Subject | General Studies |
Occupation: | Technician |
Primary ethnic origins: | Swedish |
Siblings:
# Brothers | 2 |
# Sisters | 0 |
Other:
Languages | English |
Religion | Lutheran |
Military
Branch | N/A |
Rank | N/A |
Service Yrs | 0 |
Mother's Mother
Education
Level | College |
Degree | Associate's |
Subject | Education |
Occupation: | Teacher |
Primary ethnic origins: | Swedish |
Siblings:
# Brothers | 1 |
# Sisters | 0 |
Other:
Languages | English |
Religion | Lutheran |
Military
Branch | N/A |
Rank | N/A |
Service Yrs | 0 |