WHAT IS YOUR RACE AND/OR ETHNICITY:

___________________________________________________________________________________________________________

WHITE
BLACK GREY LATIN INDIAN ASIAN MIDDLE EAST OTHER
___________________________________________________________________________________________________________


PLACE OF BIRTH:

___________________________________________________________________________________________________________

EUROPE
N. AMERICA S. AMERICA AFRICA ASIA OCEANIA OTHER
___________________________________________________________________________________________________________


WHAT IS YOUR (CLOSEST) RELIGION:

___________________________________________________________________________________________________________

CHRISTIANITY
ISLAM ATHEIST HINDUISM BUDDHISM PAGANISM OTHER
___________________________________________________________________________________________________________


I CONSIDER MYSELF:

___________________________________________________________________________________________________________

FREE
SLAVED FREE WITH LIMITATIONS SLAVED WITH FREEDOM OTHER
___________________________________________________________________________________________________________



IF I RULED THE WORLD I WOULD:
___________________________________________________________________________________________________________

DESTROY ALL & REBUILD
NO CHANGE SPREAD LOVE SPREAD FEAR OTHER
___________________________________________________________________________________________________________


SEXUAL PREFERENCE:
___________________________________________________________________________________________________________

HETROSEXUAL
GAY BISEXUAL LESBIAN TRANSGENDER NONE OTHER
___________________________________________________________________________________________________________


THE THINGS I FEAR THE MOST:
___________________________________________________________________________________________________________

HEIGHTS
THE DARK DEATH FAILURE REJECTION GOD NONE OTHER
___________________________________________________________________________________________________________


I CRY ONCE EVERY:
___________________________________________________________________________________________________________

DAY
WEEK 2 (TWO) WEEKS MONTH YEAR NEVER OTHER
___________________________________________________________________________________________________________


THIS IS THE MOST IMPORTANT THING IN MY LIFE:
___________________________________________________________________________________________________________

FREEDOM
MONEY LOVE SUCCESS HAPPINESS HEALTH NONE OTHER
___________________________________________________________________________________________________________


ARE YOU FAITHFUL:
___________________________________________________________________________________________________________

YES
NO I TRY MY BEST NOT A CHANCE NONE OTHER
___________________________________________________________________________________________________________


HAVE YOU EVER TRULY LOVED:
___________________________________________________________________________________________________________

YES
NO I DONT KNOW WHAT LOVE IS ONCE I WILL NEVER OTHER
___________________________________________________________________________________________________________


HAVE YOU EVER TRULY FELT LOVED BY SOMEONE:
___________________________________________________________________________________________________________

YES
NO I DONT KNOW WHAT LOVE IS ONCE I WILL NEVER OTHER
___________________________________________________________________________________________________________


HAVE YOU EVER LOVED SOMEONE OUTSIDE YOUR OWN FAMILY:
___________________________________________________________________________________________________________

YES
NO I DONT KNOW WHAT LOVE IS ONCE I WILL NEVER OTHER
___________________________________________________________________________________________________________


DOES/DID YOUR PARENTS LOVE YOU:
___________________________________________________________________________________________________________

YES
NO I DONT KNOW WHAT LOVE IS MY MUM MY DAD NEVER OTHER
___________________________________________________________________________________________________________


HAS ANYONE YOU LOVED DIED:
___________________________________________________________________________________________________________

YES
NO NOT YET I DONT KNOW NEVER OTHER
___________________________________________________________________________________________________________


WHAT IS YOUR FAVORITE COLOR (OR ABSENCE OF):
___________________________________________________________________________________________________________

BLACK
WHITE GREY RED BLUE GREEN YELLOW PINK OTHER
___________________________________________________________________________________________________________


WHAT AREA DO YOU WORK IN:
___________________________________________________________________________________________________________

ENTERTAINMENT
SCIENCE STUDENT FREELANCE EDUCATION FASHION OTHER
___________________________________________________________________________________________________________


DO YOU OR HAVE YOU EVER TRULY HATED:
___________________________________________________________________________________________________________

YES
NO I FEED ON HATE I NEVER FELT HATE NONE OTHER
___________________________________________________________________________________________________________


HAVE YOU GOT ANY REGRETS IN LIFE:
___________________________________________________________________________________________________________

YES
NO A LOT I NEVER REGRET ANYTHING NONE OTHER
___________________________________________________________________________________________________________


HOW OFTEN DO YOU FEEL GUILT:
___________________________________________________________________________________________________________

YES
NO A LOT I'VE NEVER FELT GUILT NONE OTHER
___________________________________________________________________________________________________________



WHERE DOES YOUR GUILT COME FROM:
___________________________________________________________________________________________________________

WORK PARTNER SOCIETY RELIGION NONE OTHER
___________________________________________________________________________________________________________



IF YOU WOULD CHANGE ONE THING ABOUT YOURSELF YOU WOULD CHANGE:

___________________________________________________________________________________________________________

MY FACE
MY SOUL EVERYTHING MY BRAIN MY MOTHER MY FATHER OTHER
___________________________________________________________________________________________________________


 
 
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