I can't remember where I find this form (it long time ago), but I decided to fill it.
The 'x' before statement means that the statement ir true.

General Info:
[ ] I am shorter than 5'4.
[x] I think I'm ugly sometimes.
[ ] I tan easily.
[ ] I wish my hair was a different color.
[ ] I have friends who have never seen my natural hair color.
[ ] I have a tattoo.
[x] I am self-conscious about my appearance.
[x] I have/I've had braces.
[x] I wear glasses/contacts.
[ ] I would get plastic surgery if it were 100% safe, free of cost, and scar-free.
[ ] I've been told I'm attractive by a complete stranger.
[ ] I have more than 2 piercing.
[ ] I have piercing in places besides my ears.
[x] I have freckles.

Family/Home Life:
[ ] I've sworn at my parents.
[ ] I've run away from home.
[ ] I've been kicked out of the house.
[x] My biological parents are together.
[ ] I have a sibling.
[x] I want to have kids someday.
[ ] I've lost a child.

School/Work:
[ ] I'm in school.
[ ] I have a job.
[ ] I've fallen asleep at work/school.
[x] I almost always do/did my homework.
[x] I've missed a week or more of school.
[ ] I failed more than 1 class last year.
[ ] I've stolen something from my job.
[ ] I've been fired.

Embarrassment:
[ ] I've slipped out a "lol" in a spoken conversation.
[x] Disney movies still make me cry.
[ ] I've peed from laughing.
[ ] I've snorted while laughing.
[x] I've laughed so hard I've cried.
[x] I've glued my hand to something.
[ ] I've had my pants rip in public.

Health:
[x] I was born with a disease/impairment .
[ ] I've gotten stitches/staples.
[ ] I've broken a bone.
[ ] I've had my tonsils removed.
[ ] I've sat in a doctor's office/emergency room with a friend.
[ ] I've had my wisdom teeth removed.
[ ] I had a serious surgery.
[x] I've had chicken pox.
[ ] I've had measles.

Traveling:
[ ] I've driven over 200 miles in one day.
[ ] I've been to Canada.
[ ] I've been to Mexico.
[ ] I've been to Niagara Falls.
[ ] I've been to Japan.
[ ] I've celebrated Mardi Gras in New Orleans.
[x] I've been to Europe .
[ ] I've been to Africa.

Experiences:
[ ] I've gotten lost in my city.
[ ] I've seen a shooting star.
[ ] I've wished on a shooting star.
[ ] I've seen a meteor shower.
[ ] I've gone out in public in my pajamas.
[ ] I've pushed all the buttons on an elevator.
[ ] I've kicked a guy where it hurts.
[ ] I've been to a casino.
[ ] I've been skydiving.
[ ] I've gone skinny dipping .
[ ] I've played spin the bottle.
[x] I've drank a whole gallon of milk in one hour.
[ ] I've crashed a car.
[x] I've been skiing.
[x] I've been in a play.
[ ] I've met someone in person from myspace.
[x] I've caught a snowflake on my tongue.
[ ] I've seen the Northern lights.
[ ] I've sat on a roof top at night.
[ ] I've played chicken.
[x] I've played a prank on someone.
[x] I've ridden in a taxi.
[ ] I've seen the Rocky Horror Picture Show.
[x] I've eaten sushi.
[ ] I've been snowboarding.

Relationships:
[x] I'm single
[ ] I'm in a relationship
[ ] I'm engaged.
[ ] I'm married.
[ ] I've gone on a blind date.
[ ] I've been the dumped more than the dumper.
[ ] I miss someone right now.
[x] I have a fear of abandonment.
[ ] I've gotten divorced.
[x] I've had feelings for someone who didn't have them back.
[x] I've told someone I loved them when I didn't.
[ ] I've kept something from a past relationship.
[ ] I've had a crush on someone of the same sex.
[ ] I've had a crush on a teacher.
[ ] I've been kissed in the rain.
[ ] I've hugged a stranger.
[ ] I have kissed a stranger

Honesty/Crime:
[x] I've done something I promised someone else I wouldn't.
[x] I've done something I promised myself I wouldn't.
[ ] I've snuck out of my house.
[ ] I have lied to my parents about where I am.
[x] I am keeping a secret from the world.
[x] I've cheated while playing a game.
[x] I've cheated on a test.
[x] I've run a red light.
[ ] I've been suspended from school.
[ ] I've witnessed a crime.
[ ] I've been in a fist fight.
[ ] I've been arrested.

Death and Suicide:
[ ] I'm afraid of dying.
[ ] I hate funerals.
[ ] I've seen someone dying.
[ ] Someone close to me has attempted suicide.
[ ] Someone close to me has committed suicide.
[ ] I've planned my own suicide.
[ ] I've attempted suicide.
[ ] I've written a eulogy for myself.

Materialism:
[ ] I own over 5 rap CDs.
[x] I own an iPod or MP3 player.
[ ] I have an unhealthy obsession with anime/manga.
[ ] I own multiple designer purses, costing over $100 a piece
[ ] I own something from Pac Sun.
[ ] I collect comic books .
[ ] I own something from The Gap.
[ ] I own something I got on e-bay.
[ ] I own something from Abercrombie.

Random Info:
[ ] I can sing well.
[ ] I've stolen a tray from a fast food restaurant.
[ ] I open up to others easily.
[x] I watch the news.
[ ] I don't kill bugs.
[ ] I hate hearing songs that sacrifice meaning for the sake of being able to rhyme.
[ ] I curse regularly.
[ ] I sing in the shower.
[ ] I am a morning person.
[x] I paid for my cell phone ring tone.
[x] I'm a snob about grammar.
[ ] I am a sports fanatic.
[ ] I twirl my hair.
[ ] I have "x"s in my screen name.
[x] I love being neat.
[ ] I love Spam.
[ ] I've copied more than 30 CD's in a day.
[ ] I bake well.
[x] My favorite color is either white, yellow, pink, red or blue
[ ] I've worn pajamas to school.
[ ] I like Martha Stewart.
[ ] I know how to shoot a gun.
[ ] I am in love with love.
[ ] I am guilty of tYpInG lIkE tHiS.
[x] I laugh at my own jokes.
[ ] I eat fast food weekly.
[ ] I believe in ghosts.
[ ] I am online 24/7, even as an away message,
[ ] I've not turned anything in and still got an A in a certain class.
[x] I can't sleep if there is a spider in the room.
[x] I am really ticklish.
[x] I love white chocolate.
[ ] I bite my nails.
[ ] I play video games.
[ ] I'm good at remembering names.
[ ] I'm good at remembering dates.
[ ] I have no idea what I want to do for the rest of my life.