PHYSICAL CHARACTERISTICS
 

Height: 5' 11"	Weight: 165	Hair Color: Light Blond
Eye Color: Blue	Hair Type: Straight	Complexion: Very Fair
Race: Caucasian	Mother's Ethnic Background: British  Father's Ethnic Background: Swedish
Blood Type: A +

FAMILY AND MEDICAL HISTORY
For each item below, if there is a history of the condition, the condition poses a risk of one percent or less to offspring.
The family relationship is indicated.

Alcoholism:	Edema:	Mental disorders:
Allergy:	Emphysema:	Mental retardation:
Anemia: MGF	Epilepsy:	Miscarriages:
Asthma:	Glaucoma:	Stillbirths:
Blindness:	Goiter:	Migraine:
Cancer: PGM (breast)	Gout:	Muscular dystrophy:
Cataracts:	Heart attack:	Myasthenia gravis:
Cirrhosis:	Heart disease:	Paraplegia:
Cleft palate or lip:	Hemophilia:	Parkinson's:
Club foot:	Hermaphroditism:	Psoriasis:
Color blindness:	Hernia, inguinal:	Sickle cell anemia:
Cystic fibrosis:	Huntington's chorea:	Tay Sachs disease:
Deafness:	Hypertension:	Thalassemia:
Diabetes:	Jaundice:	Undescended testicles:
Dislocated hip:	Juvenile arthritis:
Eczema:	Lymphedema:

ABBREVIATIONS: M=Mother, or Maternal S=Sibling F,P=Father, or Paternal
N=Nephew or Niece GF, GM=Grandfather, Grandmother
A=Aunt U=Uncle C=Cousin

MEDICAL HISTORY COMMENTS: MGF died of aplastic anemia at age 65; PGM died of breast cancer at age 40; one cousin born with fused fingers at birth (corrected surgically); parents and siblings in good health; one elderly aunt with mild MS.
 

EDUCATION:	Subject of study	Location of University	Type of University
> 1 year college	(Religion; Pre-Nursing)	Oregon	small liberal arts college with high academic and admissions standard
Baccalaureate Degree	(Religion; Pre-Nursing)	Oregon	large state university
Master's Degree
Professional Degree

OCCUPATION: Undergraduate student (Pre-Nursing)

STATE OF BIRTH: probably New Mexico     YEAR OF BIRTH: 1967     RELIGION: None

Social History:

1. Do you have any special talents?
I am interested in theater work, and I'm well coordinated which helps in physical comedy and athletics.
 

2. Are there any special talents that seem to run in your family? (athletics, music, artistic, etc.)
All of my immediate family members are athletic though not necessarily in the same fashion.

3. What are your interests and hobbies?
Theater and acting are important to me; I participated in this activity throughout high school and college, and I still am active in community theater group (non-profit).

I play various sports though nothing very organized. I try to play something every other day (usually racketball or tennis) with a workout afterwards and softball once a week during the summer.

I'm a voracious reader: just about anything but principally fiction, history and philosophy.

4. What did you enjoy studying in high school and college?
Biological science and history were of special interest to me, but I enjoyed most subjects and did uniformly well.

5. High School GPA 3.87     College GPA         I.Q. 140 though I don't much believe the idea of IQ.

6. How would you describe your personality characteristics?
Amusing, friendly, optimistic, thoughtful, patient, meticulous, witty, intelligent, laid-back, analytical, flexible, sleepy, sneezy, dopey.

7. Undergraduate major: Religion and Biology (Pre-Nursing)

Graduate major:

Additional Descriptive Characteristics:

Handedness: Foot/Shoe Size:

Hairy Chest: Hairy: Beard Color:

Any Distinguishing Features (Dimples, Cleft Chin, Roman Nose, Freckles, etc.):

Acne problems:

Reactivity/Sensitivity to sun exposure:

Do you smoke?

Family Social History:
 

	Education	Occupation	Interests
PGF
PGM
MGF	BA	YMCA and American Friends Service Committee
MGM		housewife and volunteer work	Tai Chi
Father	BS	electrician, sailor	boating and music
Mother	some college	dance instructor and massage therapist	reading and exercise
Brother	BA	in grad school (philosophy)	furniture-making and reading
Sister	in college	student	gardening and athletics
Cousin	BA	in law school	activism
Cousin	in junior high	student	kid stuff
Aunt	BA
Uncle	high school	fireman; retirement community mechanic, grounds and housing management	construction and fixing things up
Uncle	MA and law school	professor	journalism and fixing things up