= required field

    Y O U R  I N F O R M A T I O N 

    1. Male or Female MaleFemale
    2. First Name 3. Last Name
    4. Hebrew Name
    5. Street Address 6. City
    7. State 8. Zip Code
    9. Home Phone 11. Cell Phone
    10. Work Phone
    12. Your Email 13. Birthdate
    14. Height: Ft., In. 15. Build
    16. Father's Hebrew
    17. Mother's Hebrew
    18. Men: Are You a Kohain? Women: Are you able to marry a Kohain? YesNoNot Sure
    19. Are you currently on medication for a health problem? Do you have any disabilities? Please explain.

    20. Will you marry someone with a disability? YesNoPossibly

    21. Religous Education (Please Include Institutions)

    22. Secular Education (Degree Earned)

    23. Secular Education (Please Include Institutions)
    24. Occupation 25. Place of Employment
    (Name of Company)
    26. Number of years employed? 27. Have you always been observant? YesNo
    28. If not, in what year did you become observant? 29. Are you a convert? YesNo
    30. In what year did you convert? 31. Rabbi who performed your conversion, his phone number
    32. Have you ever been married? YesNo 33. Are you divorced? YesNo
    34. Widowed? YesNo
    35. What year were you divorced,widowed? Length of marriage? 36. Rabbi who arranged the Jewish divorce (get), his number
    37. Do you have children? YesNo 38. If yes, please list them by sex and age
    39. Will you marry someone
    previously married?
    YesNoPossibly 40. Will you marry someone with children? YesNoPossibly
    41. Will you want to have (more)
    children of your own?
    YesNoPossibly 42. Will you travel to meet someone? YesNoPossibly
    43. Will you relocate? YesNoPossibly 44. Which Synagogue do you attend?
    45. Who is your Rabbi, what
    is his phone number?

    46. Please list 3 or more references including relationships and phone numbers

    W H E R E  D O  Y O U  S T A N D  O N  T H E  F O L L O W I N G ?

    47. TV in your home YesNoUndecided 48. Women wearing pants YesNoUndecided
    49. Women covering hair YesNoUndecided 50. Husband learning Torah full time YesNoUndecided
    51. Husband setting aside
    time to learn Torah
    YesNoUndecided 52. Do you want to live in Israel? YesNoUndecided
    53. Will you marry a
    Ba'al Tshuva?
    YesNoUndecided 54. Will you marry a convert? YesNoUndecided

    55. Please describe yourself, e.g., your personality, your level of religious observance, your minhagim, your hobbies, interests and whatever else you think is pertinent for us to know about you.
    56. Please describe the qualities you seek in a mate, e.g., personality, level of religious observance, minhagim, physical appearance, and whatever else you think is pertinent for us to know.

    57. Referred By:

    58. Profile Picture (Format: jpg - max 10 MB)

    59. Do you allow Simcha Link to show your photo to a potential match if requested? YesNo

    In addition to filling out this form, please also email your own personal shidduch resume and picture which can be sent out to prospective matches. Email to: simchalink@chicagochesedfund.org