RAJEMATE Registration Form

Questions marked with a * are required.

PERSONAL INFORMATION
*1. Last Name
*2. First Name
3. Hebrew Name if any
*4. Date of Birth
*5. Daytime Phone
6. Evening/Alternate Phone
*7. Email address
*8. Ethnicity
*9. Would like to date only
*10. Are you a Cohen?
Yes
No
*11. Practicing Judaism
*12. Family Status
13. # of Siblings if any
14. Children if any
15. Location of birth
*16. Would you relocate?
*17. Do you want to move to Israel?
18. Hair covering after marriage
Yes
No
19. Kipa
Yes
No
20. Tzizit
JEWISH EDUCATION
*21. Jewish Education
Yes
No
22. If yes, what is the name of the school?
23. Describe in words, your family's religious background if any
SECULAR EDUCATION
24. Name of High school
25. Name of College(s) or Universities
26. Graduate School
27. Occupation
HOBBIES AND INTERESTS
28. Hobbies and interests
29. Height
30. Build
*31. Do you smoke?
Yes
No
*32. Do you smoke?
Yes
No
33. PERSONALITY TRAITS
Insecure/Nervous
Adventurous / Wild / Spontaneous
Argumentative
Artistic
Compulsive
Conservative/Clean Cut
Earthy
Easygoing / Flexible / Open-Minded
Eccentric Flamboyant
Flirtatious / Playful
Friendly / Kind
High Energy
High Maintenance
Humorous/Witty
Intellectual
Low Maintenance
Sensitive / Nurturing / Loving
Outgoing
Practical
Procrastinator
Quiet / Shy
Romantic
Self Confident
Serious / Responsible
Simple
Sophisticated / Worldly
Spiritual
Stubborn
Talkative
Unconventional / Free-Spirited
Intense
Fun-Loving
34. Please give a short description of yourself
35. Describe what you are looking for in a mate
REFERENCES
References (non-Family)
*36. Full name
*37. Phone number
Family References
*38. Full name
*39. Phone number