OOC:Census/2011 form

This survey is intended to be filled out _in character_, and if you have multiple characters, please, fill it out for each of them. Completed forms can be either a) @mailed to breisleach, or b) emailed to breisleach at gmail dot com - Receipt via email is VASTLY preferred. Deadline this year is November 5th!

This year's participation bribe: Every THIRD form I receiver will get to pick either a bottle of one of the elemental girl springs (dryad, sylph, naiad, salamander, light, dark) or 5 random tarot cards. If your form is a third, I will page or @mail you to let you know to pick your bribe. ;)

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Full Name:

Gender:

Age:

Birth race and/or Species:

Current Race and/or Species:

Do you have a Jusenkyou curse/blessing?

-If so, which one?

-Did you previously have a different blessing?

-If so, which one(s)?

Religion :

Sexual Orientation (Select One):

[ ] - Lesbian

[ ] - Bisexual, female bias

[ ] - Bisexual

[ ] - Bisexual, male bias

[ ] - Straight

[ ] - Pansexual

[ ] - Asexual

[ ] - Other (Please Specify)

[ ] - I don't believe in orientations

Place of Origin (Specify country, world, and dimension if possible) :

Level of Education (Select One):

[ ] - None at all

[ ] - Self taught, or other non-traditional form of education

[ ] - Enrolled In/Some Grade School

[ ] - Completed Grade School Only

[ ] - Enrolled In/Some Middle School

[ ] - Completed Middle School

[ ] - Enrolled In/Some Junior High

[ ] - Completed Junior High Only

[ ] - Enrolled In/Some High School

[ ] - Completed High School Only

[ ] - Enrolled In/Some Undergraduate College

[ ] - Completed Undergraduate Degree Only (If willing, please specify what in)

[ ] - Enrolled In/Some Graduate Level Studies

[ ] - Completed Master's Degree

[ ] - Completed Doctorate

[ ] - Other (Please specify or elaborate)

Languages Spoken :

Do you have any physical or mental disabilities?

-If so, what are they?

Do you have any special powers or abilities?

-If so, what are they?

Are you trained in the use of magic?

-If so, what style?

Relationship Status (Select One)

[ ] - Single, not looking , identify as monogamous

[ ] - Single, looking, identify as monogamous

[ ] - Single, not looking, identify as polyamorous

[ ] - Single, looking, identify as polyamorous

[ ] - Married, monogamous

[ ] - Committed, monogamous

[ ] - Casual, monogamous

[ ] - Married, polyamorous

[ ] - Committed, polyamorous

[ ] - Casual, polyamorous

[ ] - Other (Please Specify if possible)

Number of serious relationships you have had while living in Yuriba:

Number of times you have been married:

-If you have been married, is/was it a monogamous or a polyamorous marriage?

-If the latter, how many people are/were in the marriage?

Have you ever been divorced?

Have you ever been widowed?

Do you have any children?

-If so, how many?

-Please list the gender and ages of your children.

-Were these children born on Yuriba?

Do you have any other relatives who are currently living in/have previously lived in Yuriba?

-If so, please list their name, gender, and relationship to you, and if these individuals are adopted or birth relations.

Type of Household you live in (Select One)

[ ] - I sleep outside and/or in hotels, I do not have a regular household

[ ] - I live alone

[ ] - I live with a romantic partner or partners

-How many partners?

-Are you married to this/any of these partner(s)?

[ ] - I live with roommates (people who are not related to me by birth or adoption and are not romantically involved with me).

-How many roommates do you have? (Do not count yourself)

-Are any of your roommates romantically involved with one another?

[ ] - I live with members of my family (by birth or adoption).

-Which family members live with you?

[ ] - My household is some combination of the above situations. (Please provide specifics)

[ ] - None of the above options fit me. (Please provide specifics)

Any comments or elaborations can be noted in the space below.