EmailMe Form - Men’s Intake Questionnaire -Aja

Basic Information

Name *

First Last

Age *

Number *

Email *

Height *

Occupation / Industry *

Highest Level of Education *

Current Marital Status *

Never married

Divorced

Widowed

Have you ever been *

Never married

Divorced

Widowed

Relationship Status & Intent

What are you looking for right now? *

Marriage

Long-term relationship

Open to serious connection

Still figuring it out

How long ago was your last relationship? *

Why did your last relationship end? *

When was your last date? *

Family

Do you have children? *

Yes

No

If Yes:
How many and what ages? *

Do you want more children? *

Yes

No

Open

Location & Logistics

Are you open to long distance? *

Yes

No

Distance preference *

Local

Regional (3 hours or less)

Long distance

Values & Lifestyle

Does your partner need to share your religious beliefs? *

Yes

No

Flexible

Does your partner need to share your political views? *

Yes

No

Flexible

Do you smoke tobacco? *

Yes

No

Socially

Do you use marijuana? *

Yes

No

Socially

Do you use recreational drugs or hallucinogens? *

Yes

No

Socially

Do you drink alcohol? *

Never

Occasionally

Socially

Safety Screening

Have you ever been arrested, or convicted of ay of the following? (select all that apply) *

Personality & Alignment

List your hobbies and interests *

How would close friends describe your personality? *

Why are you interested in this particular woman? *

What stood out to you about her profile? *

Describe how you show interest when you are serious about someone *

Visibility & Participation

Are you comfortable being filmed or documented if selected?

Yes

No

Are you comfortable with public visibility related to this experiment?

Yes

No

Instagram handle (required) *

If no Instagram other social media (optional)

Photos must be:

• Clear and well-lit
• Recent (within the last 6 months)
• Unfiltered
• No group photos
• No sunglasses in all photos

Two waist-up photos

Two full-body photos

Required Disclaimer (Checkbox Before Submit) *

By submitting this form, I understand that participation does not guarantee selection, contact, or outcome. I release April Mason and affiliated parties from responsibility or liability related to interactions, meetings, or results arising from participation in this public introduction experiment.