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Questions

Academics
Military
Physical Features
Physical Aids
Facial Features
Family Information
Donor's Parents
Donor's Siblings
Father's Siblings
Mother's Siblings
Father's Parents
Mother's Parents

Personal Information

Talents:
Voice:Tenor
Instrument:
Years of experience:		Piano, Trumpet - 14, 9
Other talents:
Years of experience		Cooking - 10
Favorite:
ColorBlue
FoodShe-crab Soup
MusicTop 40, Country, Rock 'n' Roll, Classical
AnimalDog
PetFish/Cat
CarKoenigsegg Agera R
Movie"Casablanca"
Song"Johnny B. Goode" by Chuck Berry
Play"The Magic Flute"
Goals:
AcademicMD/MBA/MPH
Professional Hospital Administrator/Pharmaceutical Executive
PersonalA loving family
Religion:
Faith Christian
Denomination Russian Orthodox
Languages:
SpeakEnglish, French, Spanish
ReadEnglish, French, Spanish
WriteEnglish, French, Spanish
Sports:
PlayGolf, Ultimate Frisbee, Cross Country, Track, Tennis, Racquetball, Paintball
WatchFootball, Baseball, Golf, Hockey, Olympics
Siblings:
# Brothers1
# Sisters0
Are you a twin?
Identical or fraternal?		No
# of twins in your family0
# Identical sets0
# Fraternal sets0

Academics

Standard Test Score: provide score or denote N/A if not taken
SAT
on scale of		N/A
ACT
on scale of		32
GRE
on scale of		N/A
MCAT
on scale of		30Q
LSAT
on scale of		N/A
GMAT
on scale of		N/A
TOEFL
on scale of		N/A
Other
on scale of		USMLE STEP 1 - 229
High School
Question Response on scale of
GPA
on scale of 		3.824.0
College
Question Response on scale of
GPA
on scale of 		3.514.0
Graduate School
Question Response on scale of
GPA
on scale of 		N/A (school utilizes Honors/Pass/Fail)N/A
Subjects Studied:
Major subjectsChemistry
Minor subjectsEconomics
Degrees
Bachelor'sBA/Chemistry, Economics
Master'sPursuing Master of Business Administration
DoctoratePursuing MD
Other(s)N/A
Awards & Activities
High schoolSumma Cum Laude, Prestigious band award
CollegeDean's List 5 semesters, Paintball Club officer
AcademicHigh Honors in Ob/Gyn, Honors in Pharmacology and Pathology
Professional N/A
Political N/A
Personal Scientific Outreach program volunteer
Charitable Community Clinic
OthersN/A

Military

Served in militaryNo
BranchN/A
RankN/A
Years of service0

Physical Features

HandsRight-Handed
FingersMedium
Sizes & Measurements
Neck (inches)15
Chest (inches)40
Inseam (inches)30
Waist (inches)32
Sleeve (inches)32
Wrist (inches)7.25
Hat size7.75
Shoe size9.5

Physical Aids

Eyes:
Vision Near-Sighted
GlassesSingle
AstigmatismNo
Age started wearing glasses/contacts14
Laser surgery?No
Dental:
DeviceBraces and Retainer
ReasonCosmetic
Age range during use15-18
Other Physical Aids:
ListNone
Reason/causeN/A

Facial Features

Eyes:
Set
  • NarrowNarrow
  • AverageAverage
  • WideWide
Size
  • SmallSmall
  • AverageAverage
  • LargeLarge
Shape
  • AlmondAlmond
  • OvalOval
  • RoundRound
Color
  • Black
  • Blue
  • Green
  • Hazel
  • Brown
Shade
  • Light
  • Medium
  • Dark
Eyebrows:
Arch
  • Flat
  • Medium
  • High
Thickness
  • ThinThin
  • AverageAverage
  • ThickThick
Set
  • Narrow
  • Average
  • Wide
Nose:
Size
  • Small
  • Medium
  • Large
Shape
  • RoundRound
  • StraightStraight
  • WideWide
Width
  • Narrow
  • Average
  • Wide
Length
  • Short
  • Average
  • Long
Bridge
  • ConvexConvex
  • StraightStraight
  • ConcaveConcave
Nostril flare
  • Small
  • Average
  • Wide
Septum
  • Thin
  • Average
  • Thick
Cheekbones:
Set
  • Low
  • Average
  • High
Prominence
  • Slight
  • Medium
  • Strong
Mouth:
Size
  • SmallSmall
  • AverageAverage
  • LargeLarge
Lips
  • ThinThin
  • AverageAverage
  • FullFull
Turn
  • Downward
  • Straight
  • Upward
Teeth:
Size
  • AverageAverage
  • LargeLarge
  • SmallSmall
Set
  • Underbite
  • Even
  • Overbite
Condition
  • Poor
  • Fair
  • Good
Chin:
Shape
  • RoundRound
  • OvalOval
  • SquareSquare
Prominence
  • Slight
  • Average
  • Strong
Cleft
  • NoneNone
  • SlightSlight
  • StrongStrong
Ears:
Size
  • SmallSmall
  • AverageAverage
  • LargeLarge
Set
  • Low
  • Average
  • High
Angle
  • FlatFlat
  • AverageAverage
  • AcuteAcute
Lobe size
  • Small
  • Medium
  • Large
Lobe attachment
  • DetachedDetached
  • AttachedAttached
Hair:
Color at birth
  • Blond
  • Brown
  • Auburn
  • Red
  • Black
  • grey
Natural color in adulthood
  • Blond
  • Brown
  • Auburn
  • Red
  • Black
  • grey
Shade
  • Light
  • Medium
  • Dark
Type
  • Straight
  • Wavy
  • Curly
Fullness
  • Thin
  • Medium
  • Thick
Texture
  • Fine
  • Coarse
  • Medium
Skin:
Tone
  • Light
  • MedL
  • Med
  • MedDk
  • Dark
Tan ability
  • None
  • Slight
  • Medium
  • Easy
Condition
  • Oily
  • Medium
  • Combination
  • Dry
Hairline:
Forehead
  • Low
  • Average
  • High
Contour
  • Straight
  • Slight Curve
  • Widow Peak
Other Facial Features:
Moles
  • None
  • One
  • Several
Freckles
  • None
  • Several
  • Moderate
  • Numerous
Dimples
  • None
  • Slight
  • Medium
  • Deep
Adam's apple
  • Slight
  • Medium
  • Strong
Facial Hair
Thickness
  • Thin
  • Medium
  • Dense
Shade
  • Light
  • Medium
  • Dark

Family Information

Donor's Parents
Donor's Father Personal Information
OccupationPhysician
Donor's Father Education:
LevelGraduate school
DegreeDoctorate
SubjectMedicine
Donor's Father Religion:
Faith Christian
Denomination Episcopalian
Primary ethnic origins:German, Scottish, French
Donor's Father Languages:
SpeakEnglish
ReadEnglish
WriteEnglish
Donor's Father Talents:
VoiceTenor
Instrument
yrs experience		Saxophone - 10
Other
yrs experience		None
Donor's Father Physical Information
Body
Age62
Height5'8.5"
Weight140 lbs.
HandsRight-Handed
Donor's Father Facial Features
Eyes:
Eye ColorBrown
Eye shadeMedium
Vision Near-Sighted
GlassesBifocal
AstigmatismNo
Age started wearing glasses/contacts
yrs		14
Hair:
Original hair color Brown
If gray, age turned grayN/A
TypeStraight
Skin:
Skin ToneMedL
Skin ConditionOily
Other:
Chin cleftSlight
Ear lobeAttached
Facial DimplesNone
Military
Served in MilitaryNo
BranchN/A
RankN/A
Years of service0
Donor's Mother Personal Information
Occupation Physician
Donor's Mother Education:
LevelGraduate school
DegreeDoctorate
SubjectMedicine, Business
Donor's Mother Religion:
Faith Christian
Denomination Russian Orthodox
Primary ethnic origins:Ukrainian
Donor's Mother Languages:
SpeakEnglish, French, German
ReadEnglish, French, German
WriteEnglish, French, German
Donor's Mother Talents:
VoiceAlto
Instrument
yrs experience		Acoustic Guitar, Piano - 12, 10
Other
yrs experience		None
Donor's Mother Physical Information
Body
Age64
Height5'4.5"
Weight140 lbs.
HandsAmbidextrous
Facial Features
Eyes:
Eye ColorBlue
Eye shadeMedium
Vision Near-Sighted
GlassesBifocal
AstigmatismNo
Age started wearing glasses/contacts
yrs		15
Hair:
Original hair color Brown
If gray, age turned grayN/A
TypeCurly
Skin:
Skin ToneMedL
Skin ConditionMedium
Other:
Chin cleftSlight
Ear lobeAttached
Facial DimplesSlight
Military
Served in MilitaryNo
BranchN/A
RankN/A
Years of service0
Donor's Siblings
Donor's Sibling(s) (1-4)
Donor's Sibling #1
Full/Half siblingFull
Sibling #1 Physical Information
Body
SexMale
Age27
Height5'11"
Weight160 lbs.
HandsLeft-Handed
Sibling #1 Personal Information
Occupation Student
Education:
LevelGraduate school
DegreeDoctorate
SubjectMedicine
Religion:
Faith Christian
Denomination Russian Orthodox
Languages:
SpeakEnglish, French
ReadEnglish, French
WriteEnglish, French
Talents:
VoiceBaritone
Instrument
Years of experience		Piano, Soprano Sax, Clarinet - 20, 18, 18
Other
Years of experience		None
Sibling #1 Children:
# Boys
Ages:		0
# Girls
Ages:		0
Sibling #1 Facial Features
Eyes:
Eye colorGreen
Eye shadeMedium
Vision Normal
GlassesNone
AstigmatismNo
Age started wearing glasses/contacts0
Hair:
Original hair color Blond
If gray, age turned grayN/A
TypeCurly
Skin:
Skin toneMedL
Skin conditionMedium
Other:
Chin cleftNone
Ear lobeAttached
Facial dimplesMedium
Military
Served in militaryNo
BranchN/A
RankN/A
Years of service0
Father's Siblings
Father's Brothers
# of Brothers2
Ages of Brothers:21 (deceased), 60
Education levels for each:Some College. PhD
Occupations for each:Student, Guidance System Engineer
Religions for each:Episcopalian, Episcopalian
Father's Brothers' Total Children:
# Boys0
# Girls2
Father's Sisters
# of Sisters1
Ages of Sisters:58
Education levels for each:BSN, Master's
Occupations for each:Registered Nurse
Religions for each:Presbyterian
Father's Sisters' Total Children:
# Boys2
# Girls1
Mother's Siblings
Mother's Sisters
# Sisters3
Ages of Sisters:64, 57, 49
Education levels for each:Master's, Master's, Bachelor's
Occupations for each:Director of Social Services for a Retirement Community, Registered Dietitian and Diabetes Educator, Pharmaceutical Sales Representative
Religions for each:Russian Orthodox for all
Mother's Sisters' Total Children:
# Boys2
# Girls1
Father's Parents
Father's Father
Education
LevelGraduate
DegreeMD
SubjectMedicine
Occupation:Family Medicine
Primary ethnic origins:Scottish, French
Siblings:
# Brothers0
# Sisters0
Other:
LanguagesEnglish
ReligionEpiscopalian
Military
BranchArmy Medical Corps
RankCaptain
Service Yrs4
Father's Mother
Education
LevelGraduate
DegreeMaster's
SubjectBiology
Occupation:Medical Technologist
Primary ethnic origins:German
Siblings:
# Brothers2
# Sisters0
Other:
LanguagesEnglish
ReligionEpiscopalian
Military
BranchN/A
RankN/A
Service Yrs0
Mother's Parents
Mother's Father
Education
LevelGraduate
DegreeMD/PhD
SubjectMedicine, Chemistry
Occupation:General Surgeon
Primary ethnic origins:Ukrainian
Siblings:
# Brothers5
# Sisters3
Other:
LanguagesEnglish, Russian, Polish, German, French, Hungarian
ReligionRussian Orthodox
Military
BranchN/A
RankN/A
Service Yrs0
Mother's Mother
Education
LevelCollege
DegreeAssociate's
SubjectHome Economics
Occupation:Homemaker
Primary ethnic origins:Ukrainian
Siblings:
# Brothers7
# Sisters3
Other:
LanguagesEnglish, Russian, Polish, Hungarian
ReligionRussian Orthodox
Military
BranchN/A
RankN/A
Service Yrs0