^TheChristian Singles Info-exchange

PROFILE QUESTIONNAIRE

Revision - G

Office Hours: 9:00 a.m. to 6:00 p.m. CST Monday thru Friday, and from 1:00 p.m. to 5:00 p.m. CST on most Saturday afternoons.

Voice Line: (316) 522-3900 . . . . . . .FAX Line: (316) 529-8900

E-mail Address: mgietzen@sbcglobal.net

Visit us on the Internet at: www.christian-singles.org

The Christian Singles Info-exchange (CSI) is a nationwide, member-operated, information system for marriage-minded singles of all ages.  CSI is the largest Christian singles organization in the USA, and is also the most successful Christian singles organization in the USA in terms of marriages which have already occurred.

The mission of CSI is: "To increase the likelihood of successful marriages and to decrease the likelihood of divorce and troubled marriages in American society".

The CSI information exchange system is based on the questions contained herein.  These questions are based on the sociological "rules of companionability".

It is NOT necessary to have a computer to join and use the CSI information exchange system.

Eligibility Requirements

To be eligible to join CSI, you must be a person who:

1. is a marriage-minded* single, (See flag-note * below.)

2. is at least sixteen years old,

3. is considered eligible for marriage in your own church** and by civil laws,***

4. believes in the basic Christian principles concerning marriage and family,

5. believes in a life-long commitment to marriage,

6. believes in no sex outside of marriage,

7. shares a respect for all human beings from conception to natural death, and

8. agrees to treat all other members in a courteous manner.

* Being marriage-minded does not imply "desiring immediate marriage," rather, it means that you are open to the idea of a future marriage if and when the right partner and circumstances exist.

** If you have been previously married, and if you are a member of a religious denomination which requires an annulment prior to re-marriage, you must have the annulment prior to joining.

*** Must not be incarcerated, institutionalized, or otherwise ineligible for marriage under State or Federal law.

Profile Questionnaire Directions

TO JOIN, YOU MUST FIRST PRINT THIS FORM.

Next, complete this questionnaire and to send it to:

                   The Christian Singles Info-exchange
                   5575 South Mosley Street
                   Wichita, KS, 67216-3631

Remember to sign the membership agreement, and to enclose your membership fee and optional photograph.

To avoid having to mail numerous sheets of paper, it is okay to send your "answers only" on a separate sheet of paper, or by e-mail at: mgietzen@sbcglobal.net.  In either case, please refer to each question number followed by your response.  It's NOT necessary to repeat each question, just the question-number followed by your answers.  If your responses are hand-written, please write legibly!

This Profile Questionnaire pertains directly to you, not to the person whom you would like to meet. Answer each question with an "X," a NUMBER, or a NARRATIVE RESPONSE, in an open and honest manner.  If you don't like any of the choices offered, you may write your own response in Section 5 at Question 501.

You may either mail your photograph via US Mail, OR, you may scan your photo and send it as an e-mail attachment. If you send your photo as an e-mail file attachment, please put it in the ".bmp" or ".jpg" format, sized 2 inches tall by 1.5 inches wide.

CSI does not do a background investigation to verify the accuracy of the information given; however, if we become aware of any intentionally-given, false information, we will terminate your membership.

The narrative information in Section 5 should be concise and to the point.  Use the space available, rather than extra pages.  If you are sending your responses by e-mail or on a separate sheet of paper, use the approximate same amount of space that is allotted on this form.

If your membership is not already paid, enclose a membership payment with this Profile Questionnaire. See the last page for membership levels and details.

Make sure that CSI has your current US mailing address, and that all correspondence sent to CSI, including your photograph is clearly identified with your name and address.

Members who select you, and those whom you select, will be given the Contact Information listed below.  Therefore, do not disclose CONTACT INFORMATION below which you do not want other members to have.

Your U.S. Postal Mailing Address

(This section is for business use only and IS REQUIRED.  Other members will not see this section. The phone number is convenient, but optional.  It is OK to use a pre-printed address label here.)

Name: __________________________________________________

Addr: __________________________________________________

City: ______________________ ST: __________ Zip: ____________

Daytime Phone or Voice Recorder: (____) ______________________

Contact Information (Optional)

IMPORTANT NOTE: Our membership is made up of sincere singles, however, we cannot guarantee the "good character" of each member.  Therefore, we recommend that you correspond with members, first by mail and telephone.  We also recommend that the first few meetings be in public or with other friends, and with independent transportation.  These precautions are entirely up to you to decide on, but it is best to start a relationship in a slow and thoughtful manner.

MEMBERS WHO SELECT ME MAY CONTACT ME BY:

(Do not disclose information here that you don't want other members to have. Print neatly because other members WILL see a photo-copy of this section.)

Member No.: ________ Enter if known. If left blank, CSI will enter it for you.)

Name:______________________________________________

Addr:______________________________________________

City:______________________ ST:_____ Zip: _________

Phone: (_____)_________________ Best time:_______________

[_] FOR LADIES ONLY: (optional) I don't feel comfortable initiating the first
     communication with a gentleman, please contact me as directed above.

[_] (optional)Please contact me by mail through CSI using my Member number.
     I do not want to release any (more) contact information here.

Section 1
General Information

101. Member Number:______________ (or check below)

[_] I do NOT have a Member Number yet. (If left blank, CSI will assign a number. This number must agree with the number on the Contact Information blank above.)

102. Gender: [_] Male, [_] Female

103. Category: (Check only one number.)

[_] 1. TEEN with no previous marriage; age 16 thru 20.

[_] 2. ADULT with no previous marriage; age 21 thru 54.

[_] 3. PREVIOUSLY MARRIED; age 16 thru 54.

[_] Divorced, [_] Widowed (Check one or both blocks. If a divorced partner has passed away since the divorce, please check the "W" block instead of the "D" block.)

[_] 4. SENIOR; age 55 and better.

[_] Divorced, [_] Never married, [_] Widowed (Check each applicable block, if a divorced partner has passed away since the divorce, please check the "W" block.)

104. I was previously married _______ time(s). (Enter "0" if never married.)

105. Birth date: MO._______, DAY _____, YR ______. (Birthday is required.)

106. My religious denomination is: (Check only one number and one letter.)

[_] 1. Catholic

a. [_] Anglican       b. [_] Roman       c. [_] Other (All Eastern Rites)

[_] 2. Mormon

a. [_] Reorganized       b. [_] Traditional

[_] 3. Protestant

a. [_] Adventist	n. [_] Evangelical (Free)
b. [_] Assembly of God	o. [_] Friends Church
c. [_] Baptist	p. [_] Full Gospel
d. [_] Brethren	q. [_] Jehovah's Witness
e. [_] Charismatic	r. [_] Lutheran
f. [_] Christian	s. [_] Mennonite
g. [_] Christian Science	t. [_] Orthodox
h. [_] Church of Christ	u. [_] Pentecostal
i. [_] Church of God	v. [_] Presbyterian
j. [_] Church of the Nazarene	w. [_] Unitarian
k. [_] Community	x. [_] United Methodist
l. [_] Congregational	y. [_] Wesleyan
m. [_] Episcopalian	z. [_] Other Protestant (specify):
____________________________________________

[_] 4. Other; not listed above, (specify):__________________.

[_] 5. I am in the process of searching for a church home.

107. My race is: (List the general group you identify with, specific ethnic background is in section 2.)

108. I am approximately ________ INCHES tall, and my body build is: (Check only one.)

109. I have completed _________ years of Education. (Enter number of years. Do not include preschool nor kindergarten, but include all years after high school including trade schools. If you graduated from high school in less than twelve years, enter twelve plus any additional years.)

110. I have the following diplomas, degrees and/or professional licenses:

________________________________________________________.

111. My current primary job or occupation:

________________________________________________________.

112. My secondary job or occupation, including volunteer work (You may list more than one):

________________________________________________________.

113. My residential Zip Code is ____________, (five digits only) and the city associated with this zip code is ________________________. My residence is: (Check only one.)

[_] 1. owned by me alone. (Disregard mortgage.)
[_] 2. owned in part by me.
[_] 3. rented by me alone.
[_] 4. rented with a roommate.
[_] 5. my parent's residence.
[_] 6. other (specify):_____________________________.

114. I HAVE _______ living child(ren). (Enter number; "0" if none.)

Their age(s) is/are: ____, ____, ____, ____, ____, ____, ____,____.

115. I LIVE WITH _____ child(ren) or other dependent(s). (Include retired parents, but do not include persons who are not your dependent. Enter "0" if none.)

Their relationship to me is: and their age is:

______________________________ _________.

______________________________ _________.

______________________________ _________.

______________________________ _________.

______________________________ _________.

Section 2
Background Information

201. My general ethnic background is: (You may use combinations like "Scot/Irish" or "unknown". It is not necessary to put exact percentages or fractions.)

Country (Mother): _________________________________.

Country (Father): __________________________________.

202. I grew up in the state or foreign country of ___________________, and I lived primarily

[_] in a large City. (Approximately 50'000 or more)
[_] in a small Town. (Approximately 50'000 or less)
[_] on a Farm.
[_] in some combination of the above, or "Other".

203. I grew up with ______ sister(s), and ______ brother(s), (enter "0" if none,) and I: (Check only one.)

[_] 1. was the OLDEST or ONLY child my parents had.
[_] 2. was neither the OLDEST nor the YOUNGEST child.
[_] 3. was the YOUNGEST child in my family.
[_] 4. had a combination, due to a blended family.

204. (Enter 0, 1, or 2)______ of my parents are living, and: (Check only one.)

a. [_] are still married, or, remained married until the death of one or both.
b. [_] are separated or divorced, or, were apart prior to the death of one or both.

205. I served in the military for ______ years, ("0" if none,) and I (Check only one, or leave blank if "0" years served.)

[_] am still on Active duty.
[_] have an Honorable discharge.
[_] have an Other-than-honorable discharge.
My branch and primary military occupation was (is): ________________________________________________________ .

206. I have traveled to _______ different states, and _______ different countries. (Enter approximate number if exact number is unknown. Enter "0" if none. It is O.K. to count U.S. territories as states.)

207. My Political outlook has generally been: (Check only one.)

208. Concerning major permanent physical disabilities: (Check only one.)

[_] 1. I have NO permanent physical or emotional disabilities that limit my mobility or my ability to work.
[_] 2. I have a permanent disability, however, I am NOT dependent upon others for mobility and care. (Comment below as desired.)
[_] 3. I am dependent and/or confined. (Comment below as desired.)
Optional comment: _________________________________.

209. Concerning tobacco, for the past year I have been a: (Check only one.)

[_] 1. non-smoker and a non-chewer.
[_] 2. light smoker and a non-chewer.
[_] 3. heavy smoker and non-chewer.
[_] 4. chewer, but I don't smoke.
[_] 5. smoker and a chewer.

210. Concerning alcohol, I: (Check only one.)

[_] 1. have always been a non-drinker.
[_] 2. am now a non-drinker, past drinker.
[_] 3. limited user, on rare occasions.
[_] 4. regular user, on weekends & holidays.
[_] 5. daily or near-daily user.

211. I have _______ DUI/DWI or other alcohol related conviction(s) on record. (Enter "0" if none.)

Optional comment: _________________________________.

212. I have ______ felony conviction(s) on record. (Enter "0" if none.)

Optional comment: _________________________________.

Section 3
Values & Attitudes

There are no "right" or "wrong" answers in this section. Answer each as follows:

Enter 1, if you STRONGLY AGREE and are INFLEXIBLE about it.
Enter 2, if you AGREE but you could be FLEXIBLE about it.
Enter 3, if you feel NEUTRAL about it.
Enter 4, if you DISAGREE but you could be FLEXIBLE about it.
Enter 5, if you STRONGLY DISAGREE and are INFLEXIBLE about it.

301. _____ Married people should keep separate financial accounts.

302. _____ A married mother of young children should not work outside the home.

303. _____ Married men should share the housework if both the husband and the wife work outside of the home.

304. _____ Having more than one "general use" credit card per person, in addition to "special use cards", store cards, and discount cards, is a bad idea.

305. _____ The man should always drive.

306. _____ Pets should never be allowed in the house.

307. _____ Borrowing money for a vacation is O.K. if there is no other source of money.

308. _____ In some situations and circumstances, little white lies are better than the cruel truth.

309. _____ Smoking should not be allowed in the house.

310. _____ Physical discipline, such as spanking, is an acceptable method of child discipline.

311. _____ Children should be sent to a private school if the parents can afford it.

312. _____ Meals should be prepared by the wife on a regular schedule, except for special occasions.

313. _____ There should be no guns in the house.

314. _____ A married person should never take a job that requires them to be away from their family for extended periods of time.

315. _____ On a date, the man should always pay.

316. _____ Eating out at expensive restaurants is basically a waste of time and money.

317. _____ Using a little marijuana now and then is O.K.

318. _____ The entire family should attend church services regularly.

319. _____ The church has "no business in the bedroom," concerning contraceptives.

320. _____ Charitable donations, i.e., tithing 10% of one's income should come before family and personal expenses.

321. _____ How many children to have, if any, is primarily a decision for the wife.

322. _____ Dancing is great entertainment for married couples.

323. _____ You don't have to be "on-time" for everything.

324. _____ The TV should be OFF at meal time, when two or more family members are having a meal together.

325. _____ A woman should dress and groom herself in a way that is pleasing to her husband.

326. _____ I'd consider moving to another state, if my family would be better off financially.

327. _____ It is O.K. to play practical jokes on one's spouse.

328. _____ My spouse could have close friends of the opposite sex who are not friends of mine.

329. _____ I'm the type of person who would enjoy going to a class or family reunion.

330. _____ A man should not do women's work, and a woman should not do a man's job.

331. _____ The family should read scripture and/or pray together every day.

332. _____ Watching sports on TV is time well spent.

333. _____ It would be O.K. for my spouse to ask me to tell a lie for him or her.

334. _____ Infidelity alone, is grounds for a separation.

335. _____ Photographs of old boy/girl friends or past spouse, should be destroyed after a couple gets married.

336. _____ Vacations should be spent living spontaneously, rather than to a planned schedule.

Section 4
Life Style & Future Plans

401. After I get married, I: (Check only one.)

[_] plan to live in my Present residence.
[_] plan to Move to another residence, but stay in the same area where I now live.
[_] plan to Relocate to a different area and/or state than I now live in.
[_] have No definite plans concerning my residence, and I am willing to relocate.
[_] Other: ______________________________________.

402. My dream home would be located: (Check only one.)

[_] 1. anywhere, I am flexible about where I live.
[_] 2. on a farm, or out in the country.
[_] 3. in a small rural community.
[_] 4. in a medium sized town.
[_] 5. in a large city.

403. Concerning children, after I get married, I: (Check one number and one letter as applicable.)

[_] 1. hope to have more than one child.
[_] 2. want to have only one (more) child.
[_] 3. would consider adopting a child, but I am unable to have (more) children.
[_] 4. do not want to have any MORE children than I already have.
[_] 5. do not want any children in a future marriage.
[_] 6. am undecided, concerning future children.
[_] 7 Other (Seniors may check here without explanation, non-seniors, please specify):___________________________________.

Rh Factor (Only if you checked 1, 2, 6 or 7 and you intend to have children in the future.) My blood type is:

[_] Positive (+)
[_] Negative (-)
[_] Unknown or this does not apply to me.

404. After I get married, I (check only one):

[_] definitely plan to Continue my education, including night school if necessary.
[_] plan to continue my education, but in a Limited way.
[_] do Not plan to seek further formal education.

405. My total time spent watching TV averages about _______ hours per day. (Use nearest whole number. Do not use fractions or decimals. If less than 1/2 hour per day, enter "0".)

406. I am usually a: (Check only one.)

[_] Morning person, early to bed early to rise.
[_] Night person, up till late at night and I dread the morning alarm clock.
[_] Person somewhere Between the two above.

407. I would rather spend my free time: (Check only one.)

[_] Indoors almost always.
[_] Outdoors almost always.
[_] Both indoors and outdoors, depending upon the weather.

408. My favorite music is (You may check more than one.)

409. Some of my favorite activities are: (Check all that apply.)

Other Activities (specify):_____________________________ .

Section 5
Narrative information

501. Use this space to expand on questions that need further clarification or comment.  (Refer to the question number you are commenting on.  If space is available here, you may use it for "general comments" about yourself, i.e. characteristics not already covered by a question.)
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________.

502. I am looking for a person who has the following characteristics and traits: (Preferences)
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________.

Reverse Narrative

(This section is optional; it restricts your file to only those members who meet your standards.  If you DO NOT want to be bothered by being selected by someone who doesn't meet certain standards, i.e. age, religious denomination, race, education, etc., list those characteristics here.  These are ABSOLUTE restrictions, not mere preferences.)

503. I do not want to be selected by anyone with the following characteristics: _______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________.

Section 6
Photograph Information and Notes

Adding a photo to your profile is optional, and it DOES NOT CHANGE THE COST OF YOUR MEMBERSHIP.  A photo is recommended because photo-profiles have more activity than no-photo-profiles. About 90% of all profiles in our system contain a photograph.

Since first impressions are important, CSI recommends that you enclose or e-mail a good picture of yourself that is no more than a few years old, ...the more recent, the better!

If you don't have a suitable studio portrait of yourself, you may send any photograph or snap-shot that you desire. We can scan and re-size anything from a small postage-stamp-size photo to an 8 X 10 picture.  If the photo contains images of other people, be sure to let us know which one is you, we will frame ONLY YOU, unless you specifically want your children, pets, others, or objects to appear on the Profile Print-Out picture with you.

If sending your photo as an e-mail file, please send it in a ".bmp or .jpg" format, and size it 1.5 inches wide by 2 inches tall.

If you enclose more than one photo, CSI will scan the one that we deem to be the best suited for use on your Profile Print-Out.

Please put your name on the back of each photo.

601. Year photo(s) was/were taken: (Leave blank if not including a photo.)  ____________________.

602. Optional comment or instructions about the photo(s): (Leave blank if not including a photo.) ___________________________________.

Section 7
Membership Agreement

(Membership cannot be completed unless this Agreement is signed.)

By my signature below, I hereby certify that I meet the "Eligibility Requirements" published herein, and that all of the information given on my Profile Questionnaire is correct to the best of my knowledge.  I hereby authorize The Christian Singles Info-exchange (CSI) to release all information on My Profile Questionnaire to other members and potential members of CSI.  I do so realizing that CSI cannot guarantee that every member who selects me, or whom I select, will be of "good character."

I understand that I am under no obligation to meet with any other member, nor is any other member obliged to meet with me.  However, I agree to respond to all Selection Notices in a timely manner, and to treat all other members in a courteous manner.

I hereby agree that CSI is without liability under any circumstance, including but not limited to: the inadvertent release of confidential information, actions of other members, damage to reputation, or any other misfortune, even if such misfortune is caused by the negligence and/or fault of CSI. I hereby waive all claims against CSI, it's employees, agents, owners, directors and representatives.

SIGNATURE: _____________________. DATE: _________ 20____

Section 8
Membership Levels and Services

........................................................................

Total Amount from above: __________.

Minus Amount Already Paid or Applied to Credit Card: _________.

TOTAL ENCLOSED: _________.

* Membership fees are paid only once and are good until married with the annual $25 profile maintenance (renewal) fee.  LIMITED membership enables you to be selected by other members; however, LIMITED members may not make selections.  FULL and UNLIMITED members have both options.  Only UNLIMITED members receive New Member Screening and Automatic Notification.  LIMITED and FULL memberships may be upgraded at any time.  Previous membership payments apply to the new membership; however, information exchange fees do not apply to an upgrade.  (Membership upgrades do not change your renewal due date.)  Membership fees are not refundable after a profile is entered into the CSI system, nor after a member has received Profile Print-Outs of other members.  Group discounts are available for groups of three or more.

** FULL members pay a $15 information exchange fee for each selection made. UNLIMITED members make selections free of charge. Both FULL and UNLIMITED members are restricted to making three (3) selections in any two-week period. There is no information exchange fee for the "Selected Member" regardless of membership level.

*** There is no charge for corrections or updates to the profile questionnaire. However, when the profile is changed as a result of a change in the member's response, a $5 fee applies per change request in excess of one each 6 months.  When the profile is undergoing changes, more than one profile question may be changed for the same $5 fee.  There is no charge for changes done at renewal time or for adding/updating a photographs.

NOTE: CSI offers three (3) methods of earning VOLUNTEER CREDITS by which members may earn any, or all, of the above membership fees. Members may combine membership payments and credits. One credit is equal to one dollar as follows: (Call 316-522-3900 for specific details or click on: CREDIT FOR VOLUNTEER WORK).

Method-A. Receive 25 credits for each new member who joins, after you tell them about CSI.

Method-B. Receive 50 credits for publishing an announcement about CSI, in your church bulletin or civic club newsletter that is distributed to at least 100 people.  (You are responsible for any publishing costs, if there are any.)  Follow-up announcements earn 25 credits each, and cannot appear in the same publication more than once monthly.  To receive credit, send CSI a copy of each issue in which our announcement is published.

Section 9
Mailing Instructions and Recommendations

Regardless of the state sub-chapter you are in, please submit all completed Profile Questionnaires (or answer sheets, as specified in the directions),along with your photograph (which is optional),and your membership check or money order, as follows.

For US Mail, send to:

The Christian Singles Info-exchange
5575 South Mosley Street
Wichita, Kansas 67216-3631

In most cases, if returning the entire Profile Questionnaire, along with a photograph and check, you will need a large envelope and $1.03 in postage. However, if your printer used more than 18 pages to print this Profile Questionnaire, it will take $1.26 in postage.  (Weight of one photograph included and considered.)

If sending in an answer sheet only, it is acceptable use a smaller envelope, as long as it will accommodate your photograph. Make sure that your answer sheet contains your released contact information that is shown just previous to Section 1 above, as well as the signed membership agreement found in Section 7.

For FAX transmission dial: 1-316-529-8900

The FAX line is open 24 hours a day.  (It does NOT work well to FAX photographs.)

For electronic mail, send to: mgietzen@sbcglobal.net

See specific "e-mail" instructions for transmittal of your profile data and photograph, in the directions section above near the beginning of this Profile Questionnaire.

If paying your membership by credit card, please specify:

1. Type:  [_] AmExpress,   [_] Discover,   [_] MasterCard,   [_] Visa

2. Your card no.:__ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __

3. The expiration date on the card.  Valid THRU: _____ /_____

4. The three-digit security code from the back of your card: __ __ __

5. The total amount that you intend to pay: $____________.00

To start over on the logical progression of detailed links, go to

MISSION STATEMENT.

To join the old way (by telephone, credit card, & US Mail), go to

JOIN THE OLD WAY.

To start over completely, go to the HOME PAGE.

Duplication of this PROFILE QUESTIONNAIRE form is approved for the purpose of sharing
it with other potential CSI members, and for individual member's record keeping only. No
commercial use of this form, nor any part of it, is allowed without permission in writing from CSI.

Copyright 1989-2008 by The Christian Singles Information-exchange,  All Rights Reserved.