I General Social Data
Your name? Wife’s given and maiden name? Husband’s given name? Full names of children? Names of all other members of the household, and their relation to you? Husband’s given name: Rick J[…..] Pecoraro; Maeby the Kitten, temporary/permanent freeloader and pooper.

II Physical and Mental Conditions
What attention is given to personal hygiene and health by you? Personal hygiene: 87% accuracy.

Is the importance of regular sleep, bathing, care of the teeth, and regular action of the bowels appreciated? Sleep: on the couch between the hours of 8:15 and 10:47PM, followed by additional sleep in bed; Care of the teeth: 68% compliance (points deducted for improper use of mouthwash); Bowel action: exciting!

III Industrial History
What was your work record at these places for speed, accuracy, regularity, sobriety? An institution in which visual representations of religious figures are strongly discouraged. Previous: school for white girls.

IV Education
What was the education of each worker in your family? Did you have any vocational training? Recipient of advanced degree from private institution at a cost of $235 per month for the next several decades. No vocational training; Spouse: Reluctant degree recipient.