Questions
Personal Information
Talents:
Voice: | Tenor |
Instrument: Years of experience: | N/A |
Other talents: Years of experience | N/A |
Favorite:
Color | Green |
Food | Fried chicken |
Music | Classic country |
Animal | Bear |
Pet | Cat |
Car | Toyota 4Runner |
Movie | Braveheart |
Song | Blue Eyes Crying in the Rain |
Play | Midsummer Night’s Dream |
Goals:
Academic | Maintain board certification |
Professional | Clinical Director of Audiology |
Personal | Summit Kilimanjaro |
Religion:
Faith | Christian |
Denomination | Non-denominational |
Languages:
Speak | English |
Read | English |
Write | English |
Sports:
Play | Rugby, American Football |
Watch | All |
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 | N/A |
ACT on scale of | 28 - 36 |
GRE on scale of | 1090 - 1600 |
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 | 3.6 | 4 |
College
Question | Response | on scale of |
GPA on scale of | 3.3 | 4 |
Graduate School
Question | Response | on scale of |
GPA on scale of | 3.5 | 4 |
Subjects Studied:
Major subjects | Communication Disorders |
Minor subjects | American Sign Language |
Degrees
Bachelor's | Communication Disorders |
Master's | N/A |
Doctorate | Audiology |
Other(s) | N/A |
Awards & Activities
High school | State Champion (rugby) |
College | Collegiate All-American (rugby) |
Academic | Honor Roll (high school, 4 years), Dean’s List (college, 10 semesters) |
Professional | Board Certification (American Board of Audiology) |
Political | N/A |
Personal | N/A |
Charitable | Special Olympics Healthy Hearing volunteer |
Others | N/A |
Military
Served in military | No |
Branch | N/A |
Rank | N/A |
Years of service | N/A |
Physical Features
Hands | Right-Handed |
Fingers | Long |
Sizes & Measurements
Neck (inches) | 17 |
Chest (inches) | 44 |
Inseam (inches) | 34 |
Waist (inches) | 34 |
Sleeve (inches) | 35 |
Wrist (inches) | 9 |
Hat size | 7.38 |
Shoe size | 13.5 |
Physical Aids
Eyes:
Vision | Normal |
Glasses | None |
Astigmatism | No |
Age started wearing glasses/contacts | N/A |
Laser surgery? | No |
Dental:
Device | Braces |
Reason | Cosmetic |
Age range during use | 10-12 |
Other Physical Aids:
List | N/A |
Reason/cause | N/A |
Facial Features
Eyes:
Set |
|
Size |
|
Shape |
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Color |
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Shade |
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Eyebrows:
Arch |
|
Thickness |
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Set |
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Nose:
Size |
|
Shape |
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Width |
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Length |
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Bridge |
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Nostril flare |
|
Septum |
|
Cheekbones:
Set |
|
Prominence |
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Mouth:
Size |
|
Lips |
|
Turn |
|
Teeth:
Size |
|
Set |
|
Condition |
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Chin:
Shape |
|
Prominence |
|
Cleft |
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Ears:
Size |
|
Set |
|
Angle |
|
Lobe size |
|
Lobe attachment |
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Hair:
Color at birth |
|
Natural color in adulthood |
|
Shade |
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Type |
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Fullness |
|
Texture |
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Skin:
Tone |
|
Tan ability |
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Condition |
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Hairline:
Forehead |
|
Contour |
|
Other Facial Features:
Moles |
|
Freckles |
|
Dimples |
|
Adam's apple |
|
Facial Hair
Thickness |
|
Shade |
|
Family Information
Donor's Parents
Donor's Father Personal Information
Occupation | Social worker |
Donor's Father Education:
Level | Graduate school |
Degree | Master |
Subject | Psychology |
Donor's Father Religion:
Faith | Christian |
Denomination | Catholic |
Primary ethnic origins: | Irish, English |
Donor's Father Languages:
Speak | English |
Read | English |
Write | English |
Donor's Father Talents:
Voice | Tenor |
Instrument yrs experience | N/A |
Other yrs experience | N/A |
Donor's Father Physical Information
Body
Age | 71 |
Height | 5’10” |
Weight | 230 |
Hands | Right-Handed |
Donor's Father Facial Features
Eyes:
Eye Color | Brown |
Eye shade | Medium |
Vision | Near-Sighted |
Glasses | Bifocal |
Astigmatism | No |
Age started wearing glasses/contacts yrs | 16 - 16 |
Hair:
Original hair color | Brown |
If gray, age turned gray | 55 |
Type | Straight |
Skin:
Skin Tone | MedL |
Skin Condition | Medium |
Other:
Chin cleft | Slight |
Ear lobe | Detached |
Facial Dimples | Slight |
Military
Served in Military | No |
Branch | N/A |
Rank | N/A |
Years of service | N/A |
Donor's Mother Personal Information
Occupation | Social worker |
Donor's Mother Education:
Level | Graduate school |
Degree | Master |
Subject | Psychology |
Donor's Mother Religion:
Faith | Christian |
Denomination | Non-denominational |
Primary ethnic origins: | German, English |
Donor's Mother Languages:
Speak | English |
Read | English |
Write | English |
Donor's Mother Talents:
Voice | Tenor |
Instrument yrs experience | N/A |
Other yrs experience | N/A |
Donor's Mother Physical Information
Body
Age | 65 |
Height | 5’4” |
Weight | 160 |
Hands | Right-Handed |
Facial Features
Eyes:
Eye Color | Blue |
Eye shade | Medium |
Vision | Near-Sighted |
Glasses | Bifocal |
Astigmatism | No |
Age started wearing glasses/contacts yrs | 20 - 20 |
Hair:
Original hair color | Brown |
If gray, age turned gray | 50 |
Type | Straight |
Skin:
Skin Tone | Light |
Skin Condition | Medium |
Other:
Chin cleft | Slight |
Ear lobe | Detached |
Facial Dimples | Slight |
Military
Served in Military | No |
Branch | N/A |
Rank | N/A |
Years of service | N/A |
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 | 33 |
Height | 5’11” |
Weight | 205 |
Hands | Right-Handed |
Sibling #1 Personal Information
Occupation | Physician Assistant |
Education:
Level | Graduate school |
Degree | Other |
Subject | Physician Assistant |
Religion:
Faith | Christian |
Denomination | Non-denominational |
Languages:
Speak | English |
Read | English |
Write | English |
Talents:
Voice | Tenor |
Instrument Years of experience | N/A |
Other Years of experience | N/A |
Sibling #1 Children:
# Boys Ages: | 0 |
# Girls Ages: | 1 - 1 |
Sibling #1 Facial Features
Eyes:
Eye color | Brown |
Eye shade | Medium |
Vision | Normal |
Glasses | None |
Astigmatism | No |
Age started wearing glasses/contacts | N/A |
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 | Detached |
Facial dimples | Slight |
Military
Served in military | No |
Branch | N/A |
Rank | N/A |
Years of service | N/A |
Donor's Sibling #2
Full/Half sibling | Half |
Sibling #2 Physical Information
Body
Sex | Male |
Age | 28 |
Height | 5’9” |
Weight | 165 |
Hands | Right-Handed |
Sibling #2 Personal Information
Occupation | Actuary |
Education:
Level | College |
Degree | Bachelor |
Subject | Actuarial Science |
Religion:
Faith | Christian |
Denomination | Non-denominational |
Languages:
Speak | English |
Read | English |
Write | English |
Talents:
Voice | Tenor |
Instrument Years of experience | Trombone - 4 |
Other Years of experience | N/A |
Sibling #2 Children:
# Boys Ages: | 0 |
# Girls Ages: | 0 |
Sibling #2 Facial Features
Eyes:
Eye color | Blue |
Eye shade | Medium |
Vision | Near-Sighted |
Glasses | Bifocal |
Astigmatism | No |
Age started wearing glasses/contacts | 10 |
Hair:
Original hair color | Brown |
If gray, age turned gray | N/A |
Type | Straight |
Skin:
Skin tone | MedL |
Skin condition | Oily |
Other:
Chin cleft | Slight |
Ear lobe | Detached |
Facial dimples | Slight |
Military
Served in military | No |
Branch | N/A |
Rank | N/A |
Years of service | N/A |
Donor's Sibling #3
Full/Half sibling | Half |
Sibling #3 Physical Information
Body
Sex | Male |
Age | 16 |
Height | 5’9” |
Weight | 150 |
Hands | Right-Handed |
Sibling #3 Personal Information
Occupation | None |
Education:
Level | High school |
Degree | Not Completed |
Subject | General |
Religion:
Faith | Christian |
Denomination | Non-denominational |
Languages:
Speak | English |
Read | English |
Write | English |
Talents:
Voice | Tenor |
Instrument Years of experience | N/A |
Other Years of experience | N/A |
Sibling #3 Children:
# Boys Ages: | 0 |
# Girls Ages: | 0 |
Sibling #3 Facial Features
Eyes:
Eye color | Blue |
Eye shade | Light |
Vision | Normal |
Glasses | None |
Astigmatism | No |
Age started wearing glasses/contacts | N/A |
Hair:
Original hair color | Brown |
If gray, age turned gray | N/A |
Type | Straight |
Skin:
Skin tone | Light |
Skin condition | Medium |
Other:
Chin cleft | Slight |
Ear lobe | Detached |
Facial dimples | Slight |
Military
Served in military | No |
Branch | N/A |
Rank | N/A |
Years of service | N/A |
Father's Siblings
Father's Brothers
# of Brothers | 1 |
Ages of Brothers: | 70 |
Education levels for each: | Bachelors |
Occupations for each: | Small Business Owner |
Religions for each: | Catholic |
Father's Brothers' Total Children:
# Boys | 2 |
# Girls | N/A |
Father's Sisters
# of Sisters | 1 |
Ages of Sisters: | 69 |
Education levels for each: | Bachelors |
Occupations for each: | Accounting |
Religions for each: | Catholic |
Father's Sisters' Total Children:
# Boys | N/A |
# Girls | N/A |
Mother's Siblings
Mother's Brothers
# Brothers | 2 |
Ages of Brothers: | 60, 59 |
Education levels for each: | Bachelors, Bachelors |
Occupations for each: | Engineering, Management |
Religions for each: | Catholic (all) |
Mother's Brothers' Total Children:
# Boys | 1 |
# Girls | 2 |
Mother's Sisters
# Sisters | 4 |
Ages of Sisters: | 64, 62, 58, 55 |
Education levels for each: | High School, High School, Bachelors, Bachelors |
Occupations for each: | Insurance, Insurance, Sales, Management |
Religions for each: | Catholic (all) |
Mother's Sisters' Total Children:
# Boys | 1 |
# Girls | 1 |
Father's Parents
Father's Father
Education
Level | High school |
Degree | Diploma |
Subject | General |
Occupation: | Business Owner |
Primary ethnic origins: | Irish, English |
Siblings:
# Brothers | 0 |
# Sisters | 0 |
Other:
Languages | English |
Religion | Catholic |
Military
Branch | Army |
Rank | Military policeman |
Service Yrs | 4 |
Father's Mother
Education
Level | High school |
Degree | Diploma |
Subject | General |
Occupation: | Business Owner |
Primary ethnic origins: | English |
Siblings:
# Brothers | 0 |
# Sisters | 4 |
Other:
Languages | English |
Religion | Catholic |
Military
Branch | N/A |
Rank | N/A |
Service Yrs | 0 |
Mother's Parents
Mother's Father
Education
Level | College |
Degree | Bachelor’s |
Subject | Psychology |
Occupation: | Detective, Head of Security |
Primary ethnic origins: | German |
Siblings:
# Brothers | 1 |
# Sisters | 1 |
Other:
Languages | English |
Religion | Catholic |
Military
Branch | Army |
Rank | Bomber pilot |
Service Yrs | 4 |
Mother's Mother
Education
Level | High school |
Degree | Diploma |
Subject | General |
Occupation: | Police officer |
Primary ethnic origins: | English |
Siblings:
# Brothers | 0 |
# Sisters | 1 |
Other:
Languages | English |
Religion | Catholic |
Military
Branch | N/A |
Rank | N/A |
Service Yrs | 0 |