Educational Goals: Masters Degree in Marriage and Family Counseling
Occupational Information
Current Occupation: Student, Administrative Assistant
Career Goals: Become a Marriage and Family Therapist
Personal Health Information
Blood Type:
General Health: Good
Hearing: Good
Diet: Good
Allergies: None
Do you wear contacts or glasses?
No
Have you ever had braces? No
Have you ever had cosmetic facial surgery?
No
Please list any past or current medical problems: None
Have you ever had a problem with alcohol or substance abuse? No
Are you a smoker? No
Family Medical History
Medical Condition
Self
Family
Comments
Neurological
Cardiovascular
Blood
Respiratory
Gastrointestinal
Liver
Kidneys
Metabolic/endocrine
Skin
Bone
Senses
X
mother-corrective lenses
Allergies
Cancer
Substance abuse
Learning disability
Other
Psychological History
Have you or anyone in your immediate family ever been diagnosed with a major psychological or psychiatric disorder?(i.e. schizophrenia, bi-polar disorder, major depression) No
Have you or anyone in your immediate family ever been diagnosed with hyperactivity/ADD/ADHD? No
Genetic History
Have you or anyone in your immediate family ever been diagnosed with a birth defect? No
Have you or anyone in your immediate family ever been diagnosed with mental retardation? No
Have you or anyone in your immediate family ever been diagnosed with a genetic or chromosomal disorder? No
Reproductive History
Proven fertility: No
Have you or anyone in your immediate family ever been diagnosed with fertility problems? No
Have you or anyone in your immediate family ever suffered recurrent miscarriages and/or still births? No
Have you or anyone in your immediate family had multiple births (i.e. twins, triplets)? No
Personal Profile
Describe your personality and character: I am very outgoing, smart, funny, and friendly. I am also very honest and trustworthy.
How do you think others would describe you? Others would probably describe me as funny, silly, smart, and a good friend.
What would you say is your strongest personal trait and why? My strongest personal trait is probably my friendliness. It is easy for me to make friends and I also get along with people I meet for the first time.
What is your favorite sport? Swimming
Describe your own athletic ability/skills: I am somewhat athletic. I try to work out at least twice a week.
What is your favorite type of music? I love Country Music!
Why is this your favorite type of music? It tells a story and is mellow. Describe your own musical abilities/skills: I have no musical abilities.
Describe any other special talents, skills, hobbies or interests you may have: I like to bake and cook. I also enjoy watching movies.
What is your favorite book? The Bible Why? It teaches important things.
What is your favorite movie? Pretty Woman
Why? It is entertaining and funny.
Describe your own artistic abilities/skills: I can somewhat paint.
Have you had any unique travel experiences that you feel have helped shape your way of thinking and/or the way you live your life?
No, but I would love to travel to Europe because it has a lot of history.
Have you had any unique educational experiences? I’ve worked with teens in a teen clinic and that has taught me a lot about life and growing up.
Have you had any unique experiences with volunteer work? I did a book drive when I was in middle school for the Women’s Resource Center.
If you were given enough funds to spend one year of your life to engage in any recreational, political, religious/spiritual, or other endeavor of particular importance to you, what would you choose to do? I would like to go to Africa and help build houses for people who have nothing. I want to do this because I have a heart for African people.
Philosophies and Thoughts
What is your philosophy on life? I think that everyone has a purpose and I also believe that everyone can teach someone something.
How did you come to have this philosophy on life? I have seen it happen.
What is your ultimate goal and ambition in life? I would love to get married and have children. Also, I would like to be a successful woman.
How do you plan on achieving this goal? Continue going to school and make sure that I am living an honest life.
Why do you want to be an egg donor? I want to help women who are unable to get pregnant. Having a child is supposed to be an amazing thing and I would love to help someone accomplish that.
What do you think egg donation means to potential recipients? I am sure that they are very appreciative and that it is a blessing.
