Masjid Noor Matrimonial Registration Form
Masjid Noor Inc. offers matrimonial services solely as a community initiative and does not receive any financial benefit from it. These services aim to facilitate introductions between individuals and/or families seeking marriage for themselves or their loved ones, in accordance with Islamic principles.
APPLICANT’S INFORMATION
Full Name
First Name
Last Name
Phone #
Please enter a valid phone number.
Email
example@example.com
Date of Birth
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
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1
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31
Day
Please select a year
2025
2024
2023
2022
2021
2020
2019
2018
2017
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2014
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2012
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1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Age
Height
Weight
Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Country and City of Origin
Please specify any disability and/or health conditions, if any:
Marital Status
Please Select
Single
Divorced
Widowed
List number of children, if any:
Please Select
0
1
2
3
4
5
6
7
8
9
Specify age of each child:
PROFESSIONAL BACKGROUND
Education Background:
High School
Bachelors
Masters
Professional Degree
Please specify what you studied in
How many years it took to complete
Are you currently employed?
Yes
No
Is yes, where do you work?
Please attach current resume
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Immigration Status
US Citizen
Alien (Green Card)
Other
Is other please specify
References
Parents/Next of Kin Contact Information
First Name
Last Name
Phone #
Please enter a valid phone number.
Email
example@example.com
Profession
How they are related to you
Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please enter any additional information about you or your family that you would like toshare
Reference 1:
Name
Phone number
Reference 2:
Name
Phone number
Reference 3:
Name
Phone number
Religious Background
Religion
Sunni
Shi'ite
Other
If other please specify
In a few words, please describe your religious practices (e.g. daily prayer, fasting, attending ḥalaqāt, attending mosques, etc)
If you are a revert, please specify the date you accepted Islam
Brothers Only:
I have a beard
I do not have a beard
Sisters only – I observe (check all that apply)
Head Scarf
Jelbāb/Abāya
Niqab
None
Please check all that apply:
I smoke
I drink
I gamble
None
My Future spouse should be:
Sunni
Shi'ite
Other
Future Spouse
In a few words, please describe what religious qualities you would like in your future spouse
For sisters only – I am looking for a husband with (check all that apply):
Beard
No Beard
Either
For brothers only – I am looking for a wife that observes (check all that apply)
Head Scarf
Jelbāb/Abāya
Niqab
None
I am OK with my future spouse
Smoking
Drinking
Gambling
I am NOT okay with any of these
Ethnicity: I prefer someone from the following ethnicity, you can put open to all if you have no preference
I would prefer that my future spouse as
US Citizen
Alien (Green Card)
Other
Is other please specify
Future spouse (Check all the apply)
Single
Divorcee
Widower
I am willing to consider a person with children
Yes
No
Submitting a picture is mandatory. Your photograph will not be sent to interested parties without your prior approval. Picture requirements:- Color pictures only- Should have been taken within the last 6 months- True likeness of yourself- Full pictures
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Agreement
Agreement
I will promptly inform Masjid Noor Matrimonial Committee of any changes in the information provided above.- I authorize Masjid Noor Matrimonial Committee to utilize the information provided by me according to the needs of the service.- I pledge to keep all the information given to me by Masjid Noor Matrimonial Committee confidential.- I promise to inform Masjid Noor Matrimonial Committee as soon as a marriage takes place.- In the event of a failure to arrange such marriage, I shall not hold Masjid Noor Matrimonial Committee or the Ulema involved responsible.- By submitting this form, I agree to a complete and through criminal and background check by Masjid Noor Matrimonial Committee.
I hereby certify that the information given in this form is true, correct, and complete in every respect
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DISCLAIMER*The attachment of a photograph is Mandatory, but please be advised that the photo will be copied and sent to other applicants with your personal data only with yourapproval.* In order to expedite the process this application, it is very important to complete all required information. Any missing information may delay the processing of this application. *Please be advised, by signing this contract you approve to a Background check.
*
Date of Submission
-
Month
-
Day
Year
Date
Donation Amount (Optional)
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USD
Description
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
By using this service, you acknowledge and agree to the following terms:
No Legal Liability:
Masjid Noor Inc., its board members, volunteers, and affiliates shall not be held legally liable for any outcomes, disputes, or consequences arising from use of the matrimonial service, including but not limited to communication, meetings, compatibility, or marriage arrangements. You waive any and all rights to pursue legal action against Masjid Noor Inc. in connection with this service.
No Guarantees or Endorsements:
Masjid Noor Inc. does not guarantee the suitability, accuracy, or truthfulness of any participant's information and does not endorse any individual.
Privacy and Data Protection:
Masjid Noor Inc. will make reasonable efforts to safeguard your personal information and maintain confidentiality. However, it cannot be held responsible for unauthorized access, data breaches, or misuse of shared information beyond its control.
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