Matrimonial

Gender*

Male
Female

Name*

First Last

Home Phone

What city do you live in?*

City State / Province / Region Country

Cell Phone

Email

Best method to reach you*

Home Phone
Cell Phone
Email

Age

Height

How would you describe your build?

Slender
Average
Athletic
Muscular
Stocky
A few extra pounds
Overweight
Curvy
Full figured

Choose all that apply.

Nationality/Country of Birth

Race/Ethnicity

First Language

Other spoken language

Highest degree obtained

List major if applicable

Occupation

Are you:

Single/Never Married
Divorced
Widowed

Do you have children?

Yes
No

How many children do you have?

How old are your children?

Do you want children/additional children?

Yes
No

If you were NOT born in the United States, what is your current status?

Number of years in the USA

How often do you attend Islamic programs?

How long have you been Muslim?

How would you evaluate your Islamic knowledge?

Poor
Fair
Good
Very Good

Do you have any family in the USA?

Yes
No

Please provide relationship of your family in USA

Living Situation

Live Alone
Live With Family
Other (Explain Below)

If you answered "Other" above, please explain

Reference in the United States

First Last

Reference Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference Phone Number

Reference Email

Describe Yourself

Describe your personality and character:

Hobbies: I like to spend my time (check all that apply):

Reading
Studying
Visiting
TV & Radio
Other (Explain Below)

Other hobbies:

Maximum 150 characters

What Are You Looking For In A Future Spouse?

Are you willing to relocate?

Yes
No

What age range are you looking for?

18-24
25-34
35-44
45-54
55 and older

Preference for

Describe your expectations and requirements for a potential spouse:

List things that you would accept in a potential spouse (i.e. smoking etc.):

Do you wear complete Hijab?

Yes
No
Sometimes
Hijab + Niqab

If no, are you willing to wear it when married:

Yes
No
Undecided

Do you have a Wali?*

Yes
No

This is information is required. If you select "No," the Imam will contact you.

Wali Name

First Last

Wali Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Confirmation*

First Name Last Name

I hereby certify that the information given in this form is true, correct and complete in every respect. If there are any changes in my information I will contact BIS as soon as possible.

Initial below:*

Matrimonial Form

Describe Yourself

What Are You Looking For In A Future Spouse?