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 |
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| Size |
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| Shape |
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| Color |
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| Shade |
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Narrow
Average
Wide
Small
Average
Large
Almond
Oval
RoundEyebrows:
| Arch |
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| Thickness |
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| Set |
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Thin
Average
ThickNose:
| 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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Round
Straight
Wide
Convex
Straight
ConcaveCheekbones:
| Set |
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Mouth:
| Size |
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| Lips |
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| Turn |
|
Small
Average
Large
Thin
Average
FullTeeth:
| Size |
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| Set |
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| Gap | No |
| Condition |
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Average
Large
SmallChin:
| Shape |
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| Prominence |
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| Cleft |
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Round
Oval
Square
None
Slight
StrongEars:
| Size |
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| Set |
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| Angle |
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| Lobe size |
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| Lobe attachment |
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Small
Average
Large
Detached
AttachedHair:
| Color at birth |
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| 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 |
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Other Facial Features:
| Moles |
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| Freckles |
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| Dimples |
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| Adam's apple |
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Facial Hair
| Thickness |
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| 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 |