Note: This application will be incomplete and rejected unless accompanied by a complete financial statement, job history, lineage, and current medical report from your physician.
Name:______________________________________________________ Date of Birth:________________ Height:_____________________ Weight:______ IQ:___________________________ GPA:_____________ Social Security Number:_____ Driver’s License Number:______ Boy Scout Rank:_____________ Telephone:____________________ Home Address:______________________________________________ City:_______________________ State:________________________ Zip:_____________
1.Do you have one male and one female parent? ____ If “No”, explain:
2.Number of years your parents have been married: ____ Any brothers or sisters? ____ Are they normal? ____
3.Do you own or have access to a van? ____ A truck with oversize tires? ____ A waterbed? ____
4.Do you have an earring, nose ring, or belly button ring? ____
5.Do youi have a tattoo? ____
If you have answered YES to #3, #4 or #5, discontinue application and leave immediately.
6.In fifty words or less, what does Late mean to you?
7.In fifty words or less, what does Don’t touch my daughter mean to you?
8.In fifty words or less, what does Abstinence mean to you?
9.In fifty words or less, what does Real Pain mean to you?
10.Church/Temple you attend: ____________________________
How often do you attend: ____________________________
11.When would be the best time to interview your mother, father and priest/rabbi? ____________________________
12.Please fill in the blanks:
A. If I were shot, the last place on my body I would want wounded would be my ____________________________
B. If I were beaten, the last bone I would want broken would be my ____________________________
C. A woman’s place is in the ____________________________
The one thing I hope this application doesn’t ask is ____________________________
E. When I meet a girl, the one thing I always notice about her first is ____________________________
Note: If answer begins with “T” or “A”, discontinue and leave premises – keeping your head low and running in a serpentine fashion is advised
13.What do you want to be if you grow up?
I swear that all the above information is correct to the best of my knowledge under penalty of death, bodily harm, dismemberment, torture or mental abuse.
Signature of applicant _________________________________
Signature of father _____________________________________
Signature of mother ____________________________________
Signature of priest/rabbi ___________________________________
Signature of State Representative _________________________
Thank you for your interest, and it had better be genuine and non-sexual. Please allow 4-6 years for processing. You will be contacted in writing if approved. If denied, please never apply again. Don’t call me, I’ll call you.