Marriage Application

Marriage Application
This service adheres to the teachings of the Qur’an and the Sunnah.

All of the following information is being collected in an effort to pair people who are compatible based on their responses. There is some very personal information that is necessary. If there is any information that does NOT apply please type N/A.

It is in your best interest to be honest. This is for your benefit and the benefit of the perspective spouse.

Application approval subject to review.

NOTE: This service is only available for US residents.

Step 1: See membership below.

Step 2: Complete the form.

Step 3: Click the SUBMIT button.
Name (Legal Name)*

First NameLast Name
Address*

Street Address

CityState

Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Age*
Gender*

FemaleMale
What is your Ethnic Background?*
Height*
feet' inches"
Primary Spoken Language
Other Languages Spoken
Legal Status*

U.S. CitizenResidentNon-ImmigrantUndocumented
Are you looking for someone from a specific ethnic background?*

YesNo
Please specify what your looking for or if are open to all
Have you ever been convicted of a felony?*

YesNo
Are you willing to move or relocate?*

YesNo
What is your current marital status?*

Never been married beforeSeparatedDivorcedWidowed
Do you have pets?*

YesNo
Do you have children?*

YesNo
If you have children, how many?*

1234+None

List your children's gender and ages

	Gender	Age
Child 1
Child 2
Child 3
Child 4

Do you have custody of your minor children?*

Yes, full custodyYes, joint custodyNo
Would you like to have children/more children?*

YesNoOpen to having children/more children
What is your highest level of education?*

Less than High School DegreeHigh School/GEDTechnical or Trade SchoolAssociatesBachelorsMastersDoctorate/Terminal Degree (i.e. JD, MD, DDS, etc.)
What is your profession/job/business?*
How long have you been at your current job?*
How long have you been Muslim?*
How long have you been practicing Islam?*
Do you pray 5 times a day?*

AlwaysSometimesRarelyNever
Do you wear hijab (women) and/or dress Islamically (men)?*

AlwaysSometimesRarelyNever
Do you belong to an Islamic Community?*

YesNo
If yes, please specify the name and location of your community.
What type of Muslim do you identify as?*

Sunni MuslimShia MuslimSufiSalafiJust Muslim
Do you have any physical ailments or disabilities that may be important for the prospective spouse to know about?*

YesNo
Do you have an STDs (Sexually Transmitted Diseases) that can be passed to a prospective spouse?*

YesNo
Do you or have you ever suffered from any mental health illness?*

YesNo
Do you or have you ever been diagnosed with a chronic illness or disorder?*

YesNo
Are you currently taking medication or under treatment of any mental or physical illness?*

YesNo
Do you smoke?*

No, I have never smokedYes, I currently smoke regularlyYes, I occasionally smoke
If yes what do you smoke:
I am willing to marry who has a(n)... Please check all that apply*

Physical AilmentMental IllnessPhysical IllnessSTDFelony ConvictionI am not willing to marry someone who has any of the above.
What are your expectations for the division of responsibilities for you and your prospective spouse? (E.g. working, finances, cooking, cleaning, etc.) *
What are you looking for in a prospective spouse?*
What age range are you looking for in a prospective spouse?*
What physical body preference do you have, if any?

SlimCurvyMediumNo preferenceOther
What martial status are you looking for in a prospective spouse?*

Never previously marriedSeparatedDivorcedWidowed
What are you looking for in a prospective spouse with regard to children?*

No children from previous reltionshipsCurrently caring for minor childrenAdult children onlyMust want childrenNo more children
What are your interests and hobbies?*
How soon will you realistically be ready to be married?*

Less than 6 monthsIn 6 monthsWithin a yearLonger than a year from now
Please list any other requirements or preferences *
Do you have a Wali/Wakeel?*

YesNo
If you have a Wali/Wakeel, please include their Full Name and contact information in the box *
Reference #1: Please include your reference's Full Name and contact information in the box. (Cannot be an immediate family member)*
Reference #2: Please include your reference's Full Name and contact information in the box. (Cannot be an immediate family member)*
Is there anything else that you think we should include?*
Where did you hear about us?

InstagramFacebookWord of mouthOther
Please upload a headshot picture here*

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Please upload a full body picture here*

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This service adheres to the teachings of the Qur’an and the Sunnah.

I hereby disclose my information for private use for the sake of seeking a spouse. I hereby attest that all of the above statements are true, correct, and complete. If there is any change in the information I will notify the Service promptly (this includes if I become married or I am not looking anymore). I pledge to keep all information given to me confidential. I understand that using this Service does not guarantee I will meet a potential spouse. In the event of failure of marriage, I will not hold this service responsible.

By signing below you agree to the terms and conditions setforth in this application
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