Topher McCulloch X-2342 Application for Boyfriend Status
PLEASE REPENT

Equal access to Topher, his pants, and properties thereof is not available to all persons. My thoughts of your specialness are highly subjective. Those applicants disagreeing with this process should speak to the hand.

Position(s) enjoyed _________________________________________________  Date of date ______/______/______ Name __________________________________________________________  Credit Card # ____________________ ---------------------LAST -------------------------FIRST -------------------MIDDLE Address _______________________________________________________________________________________ ----------------------- STREET---------------------------------------------------CITY----------------------------------STATE------ZIP CODE Telephone #(____)__________  Mobile/Beeper/Other Phone # (____)__________  E-mail ______________________

How do you identify? (check all that apply) € Gay € Bisexual € Confused € Queer
Have you ever dated Topher before? € Yes € No
Would this be your first relationship? If no, please list history below. € Yes € No
Date available for dating ________/________/________ How much will you spend on me? $ ____________
Type of relationship desired € Long-term € Short-term € Platonic Adventure Friend € Serious € Non-serious
Are you able to meet the affection requirements of a hopeless romantic? € Yes € No
Have you ever been a prisoner of love? € Yes € No
Have you ever been abusive, distant, hurtful, or committed any other crime against love? € Yes € No If yes, please provide details
_________________________________________________________________________________________________________________
ANSWERING YES TO THIS QUESTION MIGHT BAR YOU FROM A RELATIONSHIP WITH ME. THEN AGAIN, WHO WOULD EVER HIT A DORKY KID WITH GLASSES LIKE ME? I'M A LOVER, NOT A FIGHTER
Do you have a car if driving is an essential relationship requirement due to distance? € Yes € No

Dating History

Provide the following information for your past four (4) significant others, boy toys, flings or hookups, starting with the most recent.

FROM--------------------TO	NAME-----------------------------------------------------------------------------GENDER
DID YOU LOVE THEM? € YES € NO	SUMMARIZE THE NATURE OF THE RELATIONSHIP
MAY WE CONTACT FOR REFERENCE? € YES € NO € LATER	REASON FOR LEAVING
FROM--------------------TO	NAME-----------------------------------------------------------------------------GENDER
DID YOU LOVE THEM? € YES € NO	SUMMARIZE THE NATURE OF THE RELATIONSHIP
MAY WE CONTACT FOR REFERENCE? € YES € NO € LATER	REASON FOR LEAVING
FROM--------------------TO	NAME-----------------------------------------------------------------------------GENDER
DID YOU LOVE THEM? € YES € NO	SUMMARIZE THE NATURE OF THE RELATIONSHIP
MAY WE CONTACT FOR REFERENCE? € YES € NO € LATER	REASON FOR LEAVING
FROM--------------------TO	NAME-----------------------------------------------------------------------------GENDER
DID YOU LOVE THEM? € YES € NO	SUMMARIZE THE NATURE OF THE RELATIONSHIP
MAY WE CONTACT FOR REFERENCE? € YES € NO € LATER	REASON FOR LEAVING