NOTE: This application will be incomplete and rejected unless
accompanied by a complete financial statement, job history, lineage,
and current medical report from your doctor.
NAME ______________________________________________
DATE of BIRTH ______________
HEIGHT __________ WEIGHT ________________
IQ _____________ GPA ______________
SOCIAL SECURITY # _______________________
DRIVERS LICENSE # ________________
BOY SCOUT RANK and BADGES
___________________________________________________
ADDRESS ________________________________
CITY/STATE ____________ ZIP __________
Do you have parents? ___Yes ___No
Is one male and the other female? ___Yes ___No
If No, please
explain:_______________________________________________________________________
How long have your parents been married?
___________________________________________
If less than your age, please explain:____________________________________________________________________________________________________________________
_______________________
ACCESSORIES SECTION:
(If you answered "Yes" to any of the above, discontinue application and leave premises.)
1. Do you own or have access to a van?
__Yes __No
2. Do you own a truck with oversized tires?
__Yes __No
3. Do you own a waterbed?
__Yes __No
4. Do you own or have access to a pickup with a mattress in the back?
__Yes __No
5. Do you currently have or are you planning on getting tattoo?
__Yes __No
6. Do you own or are you planning on owning an earring?
__Yes __No
7. Is your nose or belly button pierced?
__Yes __No
8. Is your tongue or cheek pierced?
__Yes __No
ESSAY SECTION:
In 50 words or less, what does "late" mean to you?
____________________________________________________________________________________________
___________
In 50 words or less, what does "Don't touch my daughter." mean to
you? ________________________________________________________________________
___________
In 50 words or less, what does "abstinence" mean to you?
_____________________________________________________________________________________
___________
REFERENCES SECTION:
What Church do you attend?
_____________________________________________________
How often do you attend?
________________________________________________________
When would be the best day and time to interview your:
Father _____________
Mother _____________
Pastor/Priest/Rabbi _____________
SHORT-ANSWER SECTION:
Answer by filling in the blank. Please answer freely, all answers
are confidential.
1. If I were shot, the last place I would want to be shot would be…
__________________
2. If I were beaten, the last bone I would want broken is my…
______________________
3. A woman's place is in the…
____________________________________________________
4. The one thing I hope this application does not ask me about is…
__________________
5. IF I grow up, I want to…
______________________________________________________
6. When I meet a girl, the thing I always notice about her first is…
__________________
7. The current going rate of a hotel room is…
______________________________________
I SWEAR THAT ALL INFORMATION SUPPLIED ABOVE IS TRUE AND CORRECT TO
THE BEST OF MY KNOWLEDGE UNDER PENALTY OF DEATH, DISMEMBERMENT,
CRUCIFIXION, ELECTROCUTION, AND RED HOT POKERS.
_________________________________________________________
Applicant's Signature (that means sign your name)
_______________________________
________________________________
Mother's
Signature
Father's Signature
_______________________________
________________________________
Pastor/Priest/Rabbi
State Representative/Congressman
Thank you for your interest. It had better be genuine and non-sexual
in nature. Please allow four to six years for application
processing. I will contact you in writing if you are approved.
Please do not try to call or write.
accompanied by a complete financial statement, job history, lineage,
and current medical report from your doctor.
NAME ______________________________________________
DATE of BIRTH ______________
HEIGHT __________ WEIGHT ________________
IQ _____________ GPA ______________
SOCIAL SECURITY # _______________________
DRIVERS LICENSE # ________________
BOY SCOUT RANK and BADGES
___________________________________________________
ADDRESS ________________________________
CITY/STATE ____________ ZIP __________
Do you have parents? ___Yes ___No
Is one male and the other female? ___Yes ___No
If No, please
explain:_______________________________________________________________________
How long have your parents been married?
___________________________________________
If less than your age, please explain:____________________________________________________________________________________________________________________
_______________________
ACCESSORIES SECTION:
(If you answered "Yes" to any of the above, discontinue application and leave premises.)
1. Do you own or have access to a van?
__Yes __No
2. Do you own a truck with oversized tires?
__Yes __No
3. Do you own a waterbed?
__Yes __No
4. Do you own or have access to a pickup with a mattress in the back?
__Yes __No
5. Do you currently have or are you planning on getting tattoo?
__Yes __No
6. Do you own or are you planning on owning an earring?
__Yes __No
7. Is your nose or belly button pierced?
__Yes __No
8. Is your tongue or cheek pierced?
__Yes __No
ESSAY SECTION:
In 50 words or less, what does "late" mean to you?
____________________________________________________________________________________________
___________
In 50 words or less, what does "Don't touch my daughter." mean to
you? ________________________________________________________________________
___________
In 50 words or less, what does "abstinence" mean to you?
_____________________________________________________________________________________
___________
REFERENCES SECTION:
What Church do you attend?
_____________________________________________________
How often do you attend?
________________________________________________________
When would be the best day and time to interview your:
Father _____________
Mother _____________
Pastor/Priest/Rabbi _____________
SHORT-ANSWER SECTION:
Answer by filling in the blank. Please answer freely, all answers
are confidential.
1. If I were shot, the last place I would want to be shot would be…
__________________
2. If I were beaten, the last bone I would want broken is my…
______________________
3. A woman's place is in the…
____________________________________________________
4. The one thing I hope this application does not ask me about is…
__________________
5. IF I grow up, I want to…
______________________________________________________
6. When I meet a girl, the thing I always notice about her first is…
__________________
7. The current going rate of a hotel room is…
______________________________________
I SWEAR THAT ALL INFORMATION SUPPLIED ABOVE IS TRUE AND CORRECT TO
THE BEST OF MY KNOWLEDGE UNDER PENALTY OF DEATH, DISMEMBERMENT,
CRUCIFIXION, ELECTROCUTION, AND RED HOT POKERS.
_________________________________________________________
Applicant's Signature (that means sign your name)
_______________________________
________________________________
Mother's
Signature
Father's Signature
_______________________________
________________________________
Pastor/Priest/Rabbi
State Representative/Congressman
Thank you for your interest. It had better be genuine and non-sexual
in nature. Please allow four to six years for application
processing. I will contact you in writing if you are approved.
Please do not try to call or write.
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