Last name* :

Hebrew first name* :

First name* :

Date of birth* :

Country of birth:

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YOUR ORIGIN

Father's last name :

Father's first name :

Father's job :

Father's country :

Father's religiosity :
---TraditionalPraticingModern orthodoxOrthodoxHassidish

_______________

Mother's last name :

Mother's first name :

Mother's job :

Mother's country :

Mother's religiosity :
---TraditionalPraticingModern orthodoxOrthodoxHassidish

Comments :

Convert
Year of conversion :

Comments :

________________________________________________________________________________________

YOUR PHYSIC

Height in cm* :

Style :
---LeanSlenderAverageFat

Hair :
---WhiteGreyBlackBrownRedFair

Eyes :
---BlackBrownBlueGreenGrey

Complexion :
---ClearDark skin

Comments :

________________________________________________________________________________________

YOUR PERSONNALITY

Personnality :
ReserveBalanceExtrovert

Character :

Style :
ClassicBCBGBohemianDécontractModeSportive

Comments :

________________________________________________________________________________________

YOUR PARTICULARITIES

Smoker

Physical Handicap :

Mental Handicap :

Comments :

________________________________________________________________________________________

FAMILY SITUATION

Divorced
Year of divorce :

Widow
Year of widowhood :

Number of girls :

Age :

Number of sons :

Age :

Number of children by you :

Comments :

________________________________________________________________________________________

YOUR RELIGIOSITY

TraditionalPraticingModern orthodoxOrthodoxHassidish

I light on Chabbat candles :
---Each ChabbatSome timesNever

I eat kosher :
---At homeOutsideAt home and outside

I want to progress :yesno

Techouva
Year of techouva :

I study Torah :
---Each dayOnce a weekSome timesHalf timeFull time

Comments :

________________________________________________________________________________________

My Rabbi :

My Shul :

Informations by :

________________________________________________________________________________________

YOUR PROFESSIONNAL SITUATION

Profession :

SECULAR STUDIES :

---PrimaireCollègeLycéeBACBAC+2BAC+3BAC+4BAC+5DOCTORATPLUS

JEWISH STUDIES :

LANGUAGES :

________________________________________________________________________________________

ALYAH

---Short timeMaybeNot now

________________________________________________________________________________________

YOUR HOBBIES

Pet :

Instrumental music :

Conference
Museum
Lecture
Sport
Drawing
Cinéma/Theater
Photo
Walking
Cooking

Comments :

________________________________________________________________________________________

YOUR WISHES

Age :

Height :

Character :

Personnality :

Religiosity :

Culturel level:
---PrimaireCollègeLycéeBACBAC+2BAC+3BAC+4BAC+5DOCTORATPLUS

Location :

ALYA :yesno

YOUR TWO ESSENTIAL CRITERIA
First criteria :

Second criteria :

You accept :

You refuse :

________________________________________________________________________________________

YOUR COORDINATES

Recommandation by :

Address:

Town :

Aera code :

Country :

Your home phone :

Your work phone :

Your cellphone* :

Your URL :

Your email* :

________________________________________________________________________________________

I send my picture :

I allow Keren Rachel to send my picture to anyone : yesno

________________________________________________________________________________________