Lover's Leap Questionnaire
Are you ready to take the leap?
Full Name
*
First Name
Last Name
Preferred Name
Date
*
-
Year
-
Month
Day
Date
Email Address
*
example@example.com
Primary Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Current Occupation
*
Emergency Contact Name
Emergency Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Relationship to Applicant
Pronouns
*
Zodiac Sign
*
Please Select
Aquarius
Pisces
Aries
Taurus
Gemini
Cancer
Leo
Virgo
Libra
Scorpio
Sagittarius
Capricorn
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Gender Identity
*
Cisgender
Transgender
Nonbinary
Agender
Genderfluid
Demigender
Two-Spirit
Intersex
Not Listed (Please Specify)
Sexual Orientation
*
Lesbian
Gay
Bisexual
Transgender
Queer
Intersex
Asexual
Pansexual
Heterosexual
Not Listed (Please Specify)
Racial Identity
*
White
Black
Asian
Indigenous
Hispanic/Latino
Pacific Islander
Middle Eastern/North Africa
Multiracial/Mixed Race
Not Listed (Please Specify)
When was your last relationship?
*
Less than 1 year ago
1 year - 3 years ago
Over 3 years ago
Never been in a relationship
How long was your longest relationship?
*
Less than 1 year
1 year - 3 years
Over 3 years
N/A
What type of relationship are you looking for?
*
Casual Dating
Situationship
Friends with Benefits
Polyamorous Relationship
Open Relationship
Queer Platonic Relationship
Monogamous Relationship
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Are you open to a long distance relationship?
*
Yes
No
Are you open to dating people from different cultures?
*
Yes
No
Have you ever been inlove?
*
Yes
No
It's Complicated
Do you consider yourself Introverted or Extroverted?
*
Introverted
Extroverted
Ambivert
Do you have kids?
Yes
No
Would you date someone who has kids?
Yes
No
What are your living arrangements
*
I live alone
I live with roommates
I live with my parents/family
What Personality Type are you?
*
Type A (Director), I like to be in control of every aspect of my life. Very goal-oriented and results-driven.
Type B (Socializer), I am easygoing, flexible and laid-back. Very carefree and tend to shy away from conflict.
Type C (Thinker), I am detail-oriented and like to prioritize logic and rational thinking when making decisions. Very analytical and objective.
Type D (Observer), I like to proceed at a slower, safer pace in life. Seeks security and longevity and finds comfort in routine. Dislike change and keeps to myself.
Type X, Two or more personality types are equal. List both personality types that applies. Ex: Type A&C
Please rank your Love Language preferences (First choice as number 1)
*
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What does a healthy, happy relationship look like to you?
*
What are your non-negotiable in a relationship?
*
Are you religious/spiritual, and does your partner need to be?
*
What is your political affiliation?
*
For example, Conservative, Liberal, etc.
If you are not selected to be a love interest, are you open to being a contestant?
Yes
No
Instagram Handle
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