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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*
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*
City*
State
Zip
Phone: Mobile*
Phone: Home
Email Address*

City of Birth*
Country of Birth
Years in USA (if not born here)*
Where Did You Grow Up?*
Would you consider making Aliyah to Israel?*
Would you relocate to another city?*

Father's Name*
Father's Profession*
Father's City of Birth*
Father's Status*
Mother's Name*
Mother's Profession*
Mother's City of Birth*
Mother's Status*
Parents' Marital Status*
Names and Ages of Siblings

Marital Status*
Children*
- Yes
- No
Number of Children

Height*
Eye Color*
Hair Color*

Tribe*
Grew Up*
Years of Formal Jewish Education*
Ladies - Do you plan to cover your hair after getting married?
Ladies - Do you wear skirts all of the time?
Gents - Do you wear a kippah all the time?
How often do you pray?*
How often do you study Torah?*
What synagogue do you belong to?*

Elementary School(s) Attended*
High School(s) Attended*
College(s) Attended
Highest level of Education*
Yeshivas / Seminaries Attended
Please list any post high-school Jewish Institutions that you have attended.
Occupation*

Languages You Speak*
- English
- Hebrew
- Farsi
- Russian
- Spanish
- Yiddish
- Italian
- French
- Other
What are your unique qualities?*
What are your strengths?*
What are your weaknesses?*
What are your goals in marriage?*
Hobbies and Interests*
What qualities are you looking for in a spouse?*
Height/Age Preference

References*
Reference Name / Relationship / Telephone

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