First Name *

Last Name *

Mobile Phone *

Other Phone

Email *

Facebook profile link

Instagram profile link

City *

State *

Hometown (City, State) *

Age *

Gender *

Height *

Weight *

Do you have any children? *

I am single. *

Sexual Orientation (not required)

Ethnicity (not required)

What industry do you work in? *

Occupation *

Do you like hip-hop music and/or hip-hop culture? *

Tell us about yourself! How would your friends and family best describe you? *

If you could go out on a date with any hip-hop celebrity, who would he/she be and why? *

What is your type? What characteristics are you looking for in a mate? Any turnoffs? *

Describe your dating life. *

Why do you want to be on the show? *

Filming will take place over 1-2 days sometime during mid/late October to mid November. Do you have any conflicts during this window? *

Have you ever appeared on TV / Film before? *

If yes, please give the details of the project name(s), network(s) and year(s).

How did you hear about the casting? *

If you selected OTHER, please specify.

Please upload a recent photo where we can clearly see your FACE. We prefer you use a photo of just you and no one else, without any hats or sunglasses. *

Please upload a recent photo where we can clearly see your BODY. This doesn't mean you need to be in a bathing suit, but we would like to have a full length photo of you. Please no nudes. We prefer you use a photo of just you and no one else, without any hats or sunglasses.

Please upload a video of yourself or make one here through our video recorder. Please keep your video approximately three minutes long. This is not required to apply, but it helps gives us some more insight into who you are.

Start by introducing yourself. Please tell us your name, occupation and where you currently live. Tell us why you would like to participate on the show.

PLEASE READ AND ACCEPT THE FOLLOWING *

Signature *

TODAY'S DATE *