Dating Show Application

First & Last Name

Date of Birth

Phone Number

City & State

Email Address

Social Media Link

Who are you nominating? Please provide the first and last name of the terrible dater you’re nominating and tell us why they deserve the title. Nominating yourself? If so, please provide the name of a close friend or family member who can confirm your dating history and explain why you’re a terrible dater.

Upload a headshot. No filters, sunglasses or hats please

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Upload a head-to-toe photo. No filters, sunglasses or hats please

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Upload a short video introducing yourself and telling us why you’d love the opportunity to be on a dating show!

Please record your video horizontally (landscape mode) — turn your phone sideways before you start recording. Please include your first and last name, age, city & state and your occupation.

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