Note: You may give just your first name and email address if you'd like.
Your Name: ___________________________________________
Mailing Address:
__________________________________________
__________________________________________
__________________________________________
Your E-Mail Address: ___________________________________
Height: __________
Weight: __________
Color Eyes: __________
Color Hair: _______________
Are you an adult of childbearing age?
_____Yes
_____No
If I gave you a card in person, requesting that you look at this web-site, please tell where and when you saw me so that I'll remember you. For example: In the XY store, in (name of town), on or about (date).
Highest Educational Level:
_____Non-High School Graduate
_____High School Diploma/GED
_____Some college (no degree)
_____Vocational/Technical School Certificate
_____Associate Degree
_____Bachelors Degree
_____Masters Degree
_____Doctorate Degree
If you hold a vo-tech school certificate, what was your field? Or if more than one certificate, your fields?
If you hold a college degree what was your major, or if you hold more than one college degree what was your major for each degree? (Initial degree(s) received. For example: AA, AS, BA, BS, BFA, MA, MS, MBA, PhD, MD, EdD, etc. If you hold one degree with a double major, please list both majors.)
Degree(s) Major Field(s)
What is your present job or what do you consider your career?
1. You are competing in some sort of contest with someone you like - say a friend. You would most prefer -
_____To win
_____To tie
_____To lose
2. You compete 10 times in a contest of some sort with someone you do not like. In regard to your record in these contests, you would most prefer which outcome -
_____10 Wins 0 Losses
_____7 Wins 3 Losses
_____5 Wins 5 Losses
_____3 Wins 7 Losses
_____0 Wins 10 Losses
3. When feeling 'down', you are most apt to -
_____Become more involved in activities.
_____Become quiet and reflective.
4. You are going to buy a bicycle for general use around town. You would purchase
(assume money no obstacle) -
_____A 10-speed with racing style handlebars.
_____A mountain bike.
_____A standard bike, say a 5-speed, with regular handlebars.
5. You decide to buy five accessories along with your bicycle. Mark the five you would purchase.
_____Bicycling helmet.
_____Water bottle with mounting clip.
_____Spandex shorts and/or tights.
_____Bicycling gloves.
_____Tire repair kit.
_____Clip to put around your leg to keep your pants leg out of the gears.
_____Bicycling shirt(s).
_____Tire pump.
_____A carrying apparatus of some sort with a usable volume and capacity that can be
easily attached to and removed from the bike.
_____Bicycling shoes.
6. When visiting with a good friend, you would most enjoy -
_____Talking about your respective feelings.
_____Planning a party.
7. You are going to be a runner on a track team. Choose the distance you believe you would be best at. (Don't worry about how you compare with others, only the event you think YOU would be best at. Distances in meters.)
_____100
_____400
_____800
_____1600 (or mile run)
_____10000
_____Marathon
_____Don't know.
8. You must perform one of the following jobs for 6 months at some point in the near future. Which would you choose?
_____Lead tour groups.
_____Be the occupant of a remote weather station.
9. You are in the Army. You would prefer which position?
_____Electronics technician.
_____Aide to a general. (The general is a well-behaved, friendly, professional.)
10. You win a bronze medal at the Olympics. You -
_____Are disappointed.
_____Think it's okay, but could have been better.
_____Are overjoyed.
THANK YOU