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Application to date
my Daughter(s)
(Made famous when Dr. Laura
Schlessinger read it on the air)
*NOTE: This application will be incomplete and rejected
unless accompanied by a certified financial statement, job history,
and current medical report from your doctor. Please be prepared to
submit additional information, such as psychological profile and
polygraph test, as requested.
Name ______________ Date of Birth __________
Social Security #___________ Driver’s license #
__________
IQ __________ GPA __________
Home Address __________________________________________
Do you have one male and one female parent? If not, explain:
____________________________________________
Do you own a van? ______ A truck with oversize tires?
_____
A waterbed? _____
Do you have an earring, nose ring, or belly button
ring? _____
A tattoo? _____
(If you answered YES to any of the last 5 questions, discontinue
application and leave at ONCE!)
In 50 words or less, what does “LATE” mean to you?
_____________________________________________
In 50 words or less, what does “DON’T TOUCH MY DAUGHTER”
mean to you?
_____________________________________________
In 50 words or less, what does “Abstinence” mean to
you?
_____________________________________________
What is your Church affiliation? __________________
How often do you attend? __________
Best time to interview your Parents? ___________________
Your Preacher? ________________ Your Employer?
________________
Have you ever been fingerprinted? __________
Had a DNA sample taken & recorded? __________
Answer the following questions under oath:
The one thing I hope this application does not ask about me is:
_____________________________________________
A Woman’s place is in the:
___________________________________________
My greatest fear is:
____________________________________________
When I meet a girl, the first thing I notice about her is:
_______________________
*Note: If your answer begins with a B, discontinue and LEAVE AT
ONCE, keeping your head low and running in a serpentine fashion, for
your own safety.
CERTIFICATION OF ACCURACY BY APPLICANT: I swear all
information above is true and correct to the best of my knowledge,
under penalty of death, dismemberment, Chinese water torture, and
red hot pokers.
________________________________________
SIGNATURE
(If you have to ask what this means, you are a MORON, so tear up
this application and leave immediately!)
Thank you for your interest. Please allow four to six years for
processing. You will be contacted in writing if you are approved.
Please do not try to call or write.
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