Scholastic Client Full Name: 

Address: 

City, State, Country:

Email: 

Phone Number: 

Employment/Title/Retired: 

Proof of Employment (web profile on company site/email letterhead correspondence with your name)
 

Proof of Master's or Doctorate's Degree

3 References in the Case Your Identity Needs to be Verified (Name, Title, Organization, and Phone Number): Do not use the same person who referred you.

Referred By:

Payment submitted via: Wells Fargo:

State two different words that describe your personality:

In one word, describe your worst date:

Describe the Person Who Are Looking to Establish a Long-Term Relationship With

Which race do you prefer:

Do you prefer a heterosexual only candidate (state: Yes or No):

Do you wish to attend church on your first date (state: Yes or No):

Do you wish to go to raise children between the ages of 0-17 (state: Yes or No):
 

Pressing this submit button indicates, the said named Client above agrees to all of the terms listed above and the following terms:  The Client has submitted Twenty-Five Thousand ($25,000) US Dollars to be added to this list of Scholastic Clients.  The name (first name initial and last name) of the Client is to remain on the listing until the Client is forwarded two (2) individuals (known as candidates) interested in showing how they can further intellectual stimulate the Client's mind.  The Client understands after receiving two (2) candidates' proposal, the Client's name will be removed from the listing.  The Client understands the Client can be added back onto the list for another two (2) candidates to possibly select the Client as a date at the same price indicated above.  After a second listing, the Client can no longer renew.  The Client further understands his/her personal email will only be shown to the Candidates once the Candidates' email proposal is forwarded to the Client. Upon receipt of the Candidates' email, the Client agrees to either accept or decline the offer via email or telephone.

The Client understands this Firm is not liable for any fraudulent or criminal acts of the candidates or the client.  The Client further understands there are no guarantees and no refunds.