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LA Shidduch
Helping to expedite the dating process & more
Submit My Information
Application
Thank you for your interest in LA Shidduch. We are standing by and ready to help you. Please fill out this form to be added to our database. We will review this information and be in touch!
Step 1 of 10 - General Information
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Name
*
Hebrew Name
Birthday
*
Gender
*
Male
Female
Your Photo
Upload A JPG Image
Who Referred You?
How did you hear about LA Shidduch?
Where are you now? Please provide your current contact information, not your hometown or parents' home address. We need to be able to locate you.
Street Address
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City
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State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Zip
Phone: Mobile
*
Phone: Home
Email Address
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City of Birth
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Country of Birth
Years in USA (if not born here)
*
Where Did You Grow Up?
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Would you consider making Aliyah to Israel?
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Yes
No
Undecided
Would you relocate to another city?
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Yes
No
Undecided
Father's Name
*
Father's Profession
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Father's City of Birth
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Father's Status
*
Living
Deceased
Mother's Name
*
Mother's Profession
*
Mother's City of Birth
*
Mother's Status
*
Living
Deceased
Parents' Marital Status
*
Married
Separated
Divorced
Widowed
Names and Ages of Siblings
Marital Status
*
Single
Divorced
Widowed
Separated
Children
*
Yes
No
Number of Children
Height
*
Eye Color
*
Brown
Blue
Grey
Green
Hazel
Amber
Hair Color
*
Black
Brown
Blond
Auburn
Chestnut
Red
Gray/White
Tribe
*
Yisrael
Levi
Cohen
Grew Up
*
Religious
Baal Teshuva
Years of Formal Jewish Education
*
Ladies - Do you plan to cover your hair after getting married?
Yes
No
Ladies - Do you wear skirts all of the time?
Yes
No
Gents - Do you wear a kippah all the time?
Yes
No
How often do you pray?
*
How often do you study Torah?
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Daily
Weekly
Now and Then
Other
What synagogue do you belong to?
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Elementary School(s) Attended
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High School(s) Attended
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College(s) Attended
Highest level of Education
*
High School
Bachelors
Masters
Doctorate
Yeshivas / Seminaries Attended
Please list any post high-school Jewish Institutions that you have attended.
Occupation
*
Languages You Speak
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English
Hebrew
Farsi
Russian
Spanish
Yiddish
Italian
French
Other
What are your unique qualities?
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What are your strengths?
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What are your weaknesses?
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What are your goals in marriage?
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Hobbies and Interests
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What qualities are you looking for in a spouse?
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Height/Age Preference
References
*
Reference Name / Relationship / Telephone