Extended Donor Profile for Donor: LARS alias 3107

Transcription

Extended Donor Profile for Donor: LARS alias 3107
Extended Donor Profile for Donor: LARS alias 3107
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The donor voluntarily provided the following information. This information will be disclosed to
future parents as an aid in their selection process.
A: PHYSICAL DESCRIPTION:
1.
Race: Caucasian/Scandinavian.
2.
What blood type do you have: B +
3.
Height: 6’ 2’’
4.
Weight: 176lbs
5.
Hair color: Brown
6.
Eye color: Blue/green
7.
What year were you born? 1979
8.
Build: Medium
9.
Color of eyebrow? Dark
10. Curly or straight hair? Straight
11. Hair color as a young child (0-4 years): Brown
12. Curly or straight hair as a young child (0-4 years): Straight
13. Is your hair thin, medium, or thick? Medium
14. Color of beard: Red
15. Do you wear prescription lenses? No
16. At what age did you start wearing prescription lenses?
17. Are you left or right handed? Right handed
18. Shoe size: 10
19. General clothing size: Mostly Large
20. Do you have any allergies? No
21. Do you suffer from any physical abnormalities? No
22. What is your resting heart rate? 40 beats per minute
Extended Donor Profile for Donor: LARS alias 3107
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23. What is your skin tone? Fair. I tan evenly and don’t burn too easily.
B: ACADEMICS:
1. In which percentile did you place in high school? Top 10%.
2. Which year did you graduate from high school? 1998
3. What did you do immediately after high school? Worked as a carpenter
4. In which percentile did you place during your university studies? I am a carpenter
5. Which year did you graduate from university?
6. Are you currently in school or do you work? I work
7. Describe your current school or job briefly. I am a carpenter and I am planning to study as
building technician/engineer
8. How many years have you been in school (including kindergarten)? 16 years and 5 to go
9. How many additional years do you plan on being in school? 5 years
10. What is your final degree goal? I want to work as an engineer
11. What is your native language? Danish
12. Which other languages do you speak? I have taken 8 years of English and 6 years of
German.
13. Are you more scientific, artistic or humanities oriented? I am definitely more scientific
14. What is your career goal? I want to build houses.
15. Have you been in the military? No, I did not get drafted and I chose to concentrate on my
education instead.
Extended Donor Profile for Donor: LARS alias 3107
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C: PERSONALITY:
1. What is your relationship status? I have a girlfriend. We have been together for 2 years. We
are planning to get married
2. Which words describe your personality: Spontaneous, creative, witty, leader, optimistic, easy
going, healthy looks
3. Which sports do you like to participate in? Soccer, running, skiing, climbing, surfing, waterskiing, and all other water sports
4. Which sports did you play as a child? I played soccer for one season (as a goalie), and I spent
lots of time fishing.
5. Which sports do you enjoy watching? I don’t watch sports I only participate in real life
6. Describe any additional hobbies you have: I like swimming
7. Do you play any musical instruments? I have played a guitar for a period but I was never
very good
8. Are you a member of a church? Member of the Danish church.
9. Which is your favorite color? Blue, I really like the water
10. Favorite animal: Horse, because it is a very powerful animal
11. Favorite food: T-bone steak and baked potatoes
12. Favorite type of music: I prefer pop and rock
13. Favorite car: Citroen (French)
14. Favorite pet: Dog , Boxer
15. How much sleep do you get on an average night? 7.5 hours (and I really enjoy it!)
16. Do you eat healthy? I find it important to eat healthy. I try to avoid all chemical additives
in my food
17. Are you a smoker? No, I do not smoke
18. Do you drink alcohol? I am a social drinker and enjoy alcohol occasionally.
19. Do you ride a bicycle? Yes on a hot day I often ride just for the exercise
20. What is your most memorable childhood experience? I remember our first boat and our
many fishing trips
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21. To which countries have you traveled? Norway, Sweden, Germany, Poland, Austria
22. Describe one of your favorite vacations to another country: A few years ago I went climbing
in Sweden together with a lot of other young people. I met my girlfriend there
23. Describe a few things you like the most about your own country? I think that Denmark has
many good sides. One of the best is the socialized health care and a social network for the
poorer people of society. Another really nice thing about Denmark is that it is almost
surrounded by water and there is never a long way to go swimming
24. Describe some of your strong sides. My personal skills are one of my strongest sides. I meet
new people very easily. I enjoy working in a team but can also motivate myself. Sports
skills are also one of my strong sides. I like to learn new sports. Academically I am
strongest in the sciences.
25. Describe some of your weak sides. I am a bit lazy and I am often not good to tell about my
problems.
Extended Donor Profile for Donor: LARS alias 3107
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D: FAMILY INFORMATION:
Paternal Grandfather
Age70
Alive? Yes
Ethnicity: Danish
Occupation: Farmer
Height: 175cm
Weight: 80kg
Build: Normal
Hair color: Dark brown
Eye color: Blue/grey
Heart conditions: No
Any genetic disorders: No
Maternal Grandfather
Paternal Grandmother
Age: 65
Alive? Yes
Ethnicity: Danish
Occupation: Home maker
Height: 180cm
Weight: 65kg
Build: Slim
Hair color: Brown
Eye color: Blue
Heart conditions: No
Any genetic disorders: No
Age: 76
Alive? No
Ethnicity: Danish
Occupation: Clothes shop
owner
Height: 180
Weight: 75kg
Build: Normal
Hair color: Grey
Eye color: Blue/grey
Heart conditions: No
Any genetic disorders: No
Father
Brother
Age: 78
Alive? Yes
Ethnicity: Danish
Occupation: Home Maker
Height: 160
Weight: 60kg
Build: Normal
Hair color: Grey
Eye color: Blue/grey
Heart conditions: No
Any genetic disorders: No
My grandmother is the best cook I
know!!
Mother
Age: 45
Alive? Yes
Ethnicity: Danish
Education: Wood worker
Musical? Not at all
Right or left handed? Right handed
Occupation: Teacher
Height: 170cm
Weight: 172kg
Build: Normal
Hair color: Black
Eye color: Blue/grey
Heart conditions: No
Any genetic disorders: No
Languages: English, Danish, and German
Glasses? Yes
Age: 9
Ethnicity: Danish
Occupation:
Height : Normal
Weight: Normal
Build : Normal
Hair color: Brown
Eye color: Blue
Heart conditions: No
Maternal Grandmother
Age: 42
Alive? Yes
Ethnicity: Danish
Education: Sewing
Musical? No
Right or left handed? Right handed
Occupation: Dressmaker
Height: 180cm
Weight: 60kg
Build: Slim
Hair color: Light blond
Eye color: Blue
Heart conditions: No
Any genetic disorders: No
Languages: English, Danish, and German
Glasses? Yes
Brother
Full or half? Full
Age: 12
Alive? Yes
Ethnicity: Danish
Occupation:
Height: normal
Build: Athletic
Hair color: Brown
Eye color: Blue
Heart conditions: No
Any genetic disorders: No
Brother
Age:14
Ethnicity: Danish
Occupation:
Height: Tall
Weight: Normal
Build: Normal
Hair color: Brown
Eye color: Grey
Heart conditions: No
I have 3 smaller brothers and one older
sister. My sister gave birth to twins last
year
Extended Donor Profile for Donor: LARS alias 3107
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Do you have any children? No
If yes, please describe in detail (include physical description, personality, medical information….):
E: MEDICAL INFORMATION:
Do you have any medical conditions? no
If yes, please list:
F: PERSONAL MESSAGE FROM DONOR:
Hand written: Motivation for donation, personal message to family, further information about
yourself….