Questions
Personal Information
Talents:
Voice: | Baritone |
Tell us about your interests/talents and how long you have been pursuing. Provide several. | I have been swimming ever since I was a kid, about 25 years now. I also started going hiking at a young age and stilll enjoy it so about 20 years. I've been playing tennis for 16 years. I have been a history buff for a while and occasionally go to historical reenactments. |
Favorite:
Color | Blue |
Food | Asian |
Music | Rock |
Animal | Dogs |
Pet | Beagle named Snoopy |
Car | Wrangler |
Movie | The Godfather (not the third one) |
Song | Stairway to Heaven |
Goals:
Academic | To finish residency. |
Professional | To become a partner in a private practice and continue my participation in both the state and national psychiatric organizations. Ultimately, I hope to contribute to the content of the DSM VI. |
Personal | To finish the Appalachian Trail |
Religion:
Faith | Other |
Denomination | Agnostic |
Languages:
Speak | English and Spanish |
Sports:
Play | Swim, lacrosse, and tennis |
Watch | Football, hockey, and basketball |
Siblings:
Are you or any of your siblings twins? Please specify who and if they are fraternal or identical | No |
Academics
Standard Test Score: provide score or denote N/A if not taken
SAT on scale of | 1450 - 1600 |
ACT on scale of | N/A - N/A |
GRE on scale of | N/A - N/A |
MCAT on scale of | 520 - 528 |
LSAT on scale of | N/A - N/A |
GMAT on scale of | N/A - N/A |
TOEFL on scale of | N/A - N/A |
Other on scale of | N/A - N/A |
High School
Question | Response | on scale of |
GPA on scale of | 3.75 | 4.0 |
College
Question | Response | on scale of |
GPA on scale of | 3.51 | 4.0 |
Graduate School
Question | Response | on scale of |
GPA on scale of | 87.8 | 100 |
Subjects Studied:
Major subjects | Psychology; Medicine and Psychiatry |
Minor subjects | Political Science |
Degrees
Bachelor's | BA/Psychology |
Master's | N/A |
Doctorate | DO/Doctor of Osteopathic Medicine |
Other(s) | N/A |
Awards & Activities
High school | Lacrosse, swimming, lifeguarding, state lifeguard competitions |
College | Swimming club, philanthropy chair of fraternity |
Academic | Dean's List, Cum Laude in BA program |
Professional | Member of American Psychiatric Association and executive board member of the state psychiatric association |
Political | Patient advocacy by reaching out to state lawmakers |
Personal | Outdoors: hiking, tennis, and swimming |
Charitable | Volunteer clinic |
Others | Speak fluent Spanish |
Military
Served in military | No |
Branch | N/A |
Rank | N/A |
Years of service | N/A |
Physical Features
Hands | Right-Handed |
Fingers | Medium |
Sizes & Measurements
Neck (inches) | 16 |
Chest (inches) | 41 |
Inseam (inches) | 32 |
Waist (inches) | 38 |
Sleeve (inches) | 32 |
Hat size | 7 ¾ |
Shoe size | 12 |
Physical Aids
Eyes:
Vision | Normal |
Glasses | None |
Astigmatism | No |
Age started wearing glasses/contacts | N/A |
Laser surgery? | No |
Dental:
Device | None |
Reason | N/A |
Age range during use | N/A |
Other Physical Aids:
List | None |
Reason/cause | N/A |
Facial Features
Eyes:
Set |
|
Size |
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Shape |
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Color |
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Shade |
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Eyebrows:
Arch |
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Thickness |
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Set |
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Nose:
Size |
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Shape |
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Width |
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Length |
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Bridge |
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Nostril flare |
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Cheekbones:
Set |
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Mouth:
Size |
|
Lips |
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Turn |
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Teeth:
Size |
|
Set |
|
Gap | No |
Condition |
|
Chin:
Shape |
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Prominence |
|
Cleft |
|
Ears:
Size |
|
Set |
|
Angle |
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Lobe size |
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Lobe attachment |
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Hair:
Color at birth |
|
Natural color in adulthood |
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Shade |
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Type |
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Fullness |
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Texture |
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Skin:
Tone More about skin tones |
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Tan ability |
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Condition |
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Hairline:
Forehead |
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Contour |
|
Other Facial Features:
Moles |
|
Freckles |
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Dimples |
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Adam's apple |
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Facial Hair
Thickness |
|
Color |
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Shade |
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Family Information
Donor's Parents
Donor's Father Personal Information
Occupation | Environmental Engineer |
Donor's Father Education:
Level | Graduate school |
Degree | Master |
Subject | Environmental engineering |
Donor's Father Religion:
Faith | Christian |
Denomination | Roman Catholic |
Donor's Father Languages:
Speak | English |
Donor's Father Talents:
Voice | Bass |
Instrument | Guitar |
Other | None |
Donor's Father Physical Information
Body
Age | 68 |
Height | 5'10" |
Weight | 170 lbs. |
Hands | Right-Handed |
Donor's Father Facial Features
Eyes:
Eye Color | Green |
Eye shade | Medium |
Corrective Lenses | No |
Hair:
Original hair color | Brown |
Type | Wavy |
Skin:
Skin Tone More about skin tones | Ivory |
Other:
Chin cleft | Medium |
Ear lobe | Detached |
Facial Dimples | None |
Donor's Mother Personal Information
Occupation | Psychotherapist and Artist |
Donor's Mother Education:
Level | Graduate school |
Degree | Master |
Subject | Social work/psychotherapy and Fine Arts |
Donor's Mother Religion:
Faith | Christian |
Denomination | Roman Catholic |
Donor's Mother Languages:
Speak | English |
Donor's Mother Talents:
Voice | Soprano |
Instrument | None |
Other | Fine art via stencils, has been featured in galleries |
Donor's Mother Physical Information
Body
Age | 67 |
Height | 5'8" |
Weight | 150 lbs. |
Hands | Right-Handed |
Facial Features
Eyes:
Eye Color | Blue |
Eye shade | Medium |
Corrective Lenses | No |
Hair:
Original hair color | Brown |
Type | Straight |
Skin:
Skin Tone More about skin tones | Porcelain |
Other:
Chin cleft | None |
Ear lobe | Detached |
Facial Dimples | Medium |
Donor's Siblings
Donor's Sibling(s) (1-4)
Donor's Sibling #1
Full/Half sibling | Full |
Sibling #1 Physical Information
Body
Age | 34 |
Height | 5'8" |
Weight | 150 lbs. |
Hands | Right-Handed |
Sibling #1 Personal Information
Occupation | Journalist |
Education:
Level | College |
Degree | Bachelor |
Subject | Communications |
Languages:
Speak | English |
Talents:
Voice | Soprano |
Instrument | None |
Other | Writer |
Sibling #1 Children:
# Boys Ages: | 2 - 3, 1 |
# Girls Ages: | 0 |
Sibling #1 Facial Features
Eyes:
Eye color | Blue |
Eye shade | Medium |
Corrective Lenses | No |
Hair:
Original hair color | Brown |
Type | Straight |
Skin:
Skin tone More about skin tones | Ivory |
Other:
Chin cleft | None |
Ear lobe | Detached |
Facial dimples | Medium |
Father's Siblings
Father's Brothers
# of Brothers | 1 |
Ages of Brothers: | 76 |
Education levels for each: | Graduate School |
Occupations for each: | Engineer |
Father's Brothers' Total Children:
# Boys | N/A |
# Girls | N/A |
Father's Sisters
# of Sisters | 1 |
Ages of Sisters: | 74 |
Education levels for each: | College |
Occupations for each: | Interior Designer |
Father's Sisters' Total Children:
# Boys | 2 |
# Girls | N/A |
Mother's Siblings
Mother's Brothers
# Brothers | 2 |
Ages of Brothers: | 80, 74 |
Education levels for each: | College, College |
Occupations for each: | Accountant, Accountant |
Mother's Brothers' Total Children:
# Boys | 3 |
# Girls | 2 |
Mother's Sisters
# Sisters | 1 |
Ages of Sisters: | 76 |
Education levels for each: | College |
Occupations for each: | Saleswoman |
Mother's Sisters' Total Children:
# Boys | 0 |
# Girls | N/A |
Father's Parents
Father's Father
Education
Level | Graduate school |
Degree | Master |
Occupation: | Engineering |
Siblings:
# Brothers | 2 |
# Sisters | 1 |
Other:
Languages | English |
Religion | Christian |
Father's Mother
Education
Level | College |
Degree | Bachelor |
Occupation: | Artist |
Siblings:
# Brothers | 1 |
# Sisters | 3 |
Other:
Languages | English |
Religion | Christian |
Mother's Parents
Mother's Father
Education
Level | College |
Degree | Bachelor |
Occupation: | Police officer |
Siblings:
# Brothers | 1 |
# Sisters | 1 |
Other:
Languages | English |
Religion | Christian |
Mother's Mother
Education
Level | College |
Degree | Bachelor |
Occupation: | Artist/Graphic Design |
Siblings:
# Brothers | 2 |
# Sisters | 3 |
Other:
Languages | English |
Religion | Christian |