FREE DATING EVALUATION

 

Individuals are considered for membership with our organization based on attitude, character, eligibility, and a serious desire to meet quality single people. 

The following dating evaluation is the initial part of our screening process, which along with your personal interview, determines qualification for membership.

The red asterisk (*) indicates a required field. You should answer all questions that apply to you. The more questions you answer, the more we can help you.  Also, please fill them out correctly so we can quickly process your form and get back with you and show you a great way of meeting local singles!
 

 

All information provided will be used only by MMH personnel and will not be shared with any other party.

 

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First Name

Middle Initial

*

Last Name

 

 

*

Age

*Date of Birth

*

Sex

 Male    Female

 

 

*

Street Address

 

 

*

City

*State

*

Zip Code

 

 

*

eMail Address

 

 

*

Home Phone

  

 

 

 

Work Phone

  

 

 

 

Fax

  

 

 

 

Good time for MMH to contact you.

 

 

 

Work Hours

 

 

 

Your Personal Website

 

 

Marital Status

 

 

Number Of Children

Children At Home

Children’s Ages

 

 

 

 

 

 

Level Of Education

 

 

Degree/Major

 

 

New to the area?

 Yes   No

 

 

Employment

 

 

Occupation

 

 

Annual Income

 

 

Tell us a bit more about yourself, your lifestyle, etc.

 

 

Your Relationship Goals

(To make multiple selections hold down the “Control” key while selecting.)

 

 

 

 

 

How long have you considered an alternative means (Periodical personals, online, etc.) to meet someone?

 

 

 

 

 

 

What other ways have you tried to meet someone?

(To make multiple selections hold down the “Control” key while selecting.)

 

Activities/interests you would share with someone special.

(To make multiple selections hold down the “Control” key while selecting.)

 

 

Other, please describe:

 

 

 

 

 

What hinders your success in meeting “that special someone”?

(To make multiple selections hold down the “Control” key while selecting.)

 

 

(Select all that apply.)

What would you like to know about someone before a first date?

Age   Looks     Occupation

Religious Beliefs   Sophistication

Smoker   Non-smoker

Have children   Children at home

 

Maturity Level   Spontaneity

 

Introvert   Extrovert

 

Education   Income

 

Ethical/Moral Standards

 

Other, please describe:

 

Preferred height range of someone you would date.

 

 

Preferred age range of someone you would date.

 

 

 

 

 

 

How often do you go out on a first date?

 Times per week

 

 

 

 Times per month

 

 

How often are you asked on a date?

 

 

 

 

 

 

If you don’t join Match Made In Heaven, how will you try to meet someone special?

 

 

 

 

 

 

Any other relevent information about yourself, questions or comments.

 

 

How did you hear of Match Made in Heaven?

Search Engine

  

KXOJ

K-LOVE

  

Other Radio

Television

 

Other

  

Please Explain

To ensure the best possible service from MMH, please check all your responses for completeness and accuracy. Again, rest assured the information you provide will remain strictly confidential and will not be shared with any third parties.

 

(This will clear all entered responses.)