Islamic Education Resource Foundation

Muslim Marriage Application Form


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In the Name of Allah, the Most Beneficent, the Most Merciful


The personal information you provide in this form such as your name, phone, email, date of birth will be kept confidential and the rest of the information will form a profile (to see a sample click here) which will be provided on Google Group the access to which will be provided to the interested applicants only for their review to select a suitable match. You will be indentified to the interested person only after your permission. Therefore, a Gmail account will be needed in order for you to be able to review the profiles. If you don't have a Gamil you could obtain one and provide it later by calling.

By Submitting this form you agree that no responsibility should ever arise against anyone providing or assisting in this marriage coordination service.  

The purpose of this form is to collect your information and your requirements of a suitable spouse.

Due to a Technical Difficulty with the web site form,  we have established a temporary means until the problem is solved. kindly download the following excel file and after completing the info. email it to

for help call Abo-Ahmad at 626-462-9117


Please provide the following information:

Gender:  Sister        Brother  

 Because some applicants may consider Sunni or Shi'i to be one of the determining factors as any other factor on this form.  Therefore, to save feeling, time and efforts for all, kindly check the appropriate button:  

Islamic Sect: Sunni    Shi'i     Others      

First Name

Last Name

Middle Initial

Cell Phone

Home Phone


Location:      City



Enter your date of birth, kindly provide your input in the exact format shown: 2 digits for both the month

and day and 4 digits for the year also you must include the slashes (/).

(for your security: do not enter the exact day of the month & enter approx date to help calculate your age):

  -- mm/dd/yyyy


Health condition:



  Smoking    Non-Smoking


Height in (ft-in) as (x'-xx"):

Weight in pounds:



Language (s):

Your current education level:

Less than High School
High school
College graduate
Higher than college graduate

Field of your degree:

Country of origin:

Residency status:

U.S. Citizen

If marriage is required for residency, please also check this box 

How long have you been in USA (years)?


Marital status:


With Children

If you have children: Enter number,  gender,  age(s):

Extent of your Islamic practice:

For Sister only, if you are:

Currently Observing Hijab, check this box only:         

Not Observing Hijab but Willing to observe, check this box only: 


Are you willing to support your spouse for residency?

Yes    No

A brief description about you in addition to the items above, including your goals of life,

your interest, .etc.

======.=======  YOUR REQUIREMENT OF THE SPOUSE  =======.========

Minimum age of spouse:

Max. age of spouse:

Spouse complexion: select as many of the following options that are acceptable to you:



Spouse Smoking:

  Smoking    Non-Smoking


Spouse Islamic practice:


For brothers only: If you are willing to consider a sister not observing

 Hijab, then skip this and go to Spouse ethnic below. Otherwise:

If you require the spouse to observe hijab, check this box only:   

 But if you are willing to consider a sister willing to observe hijab,

check this box only:    


Spouse ethnic background in order of preference:

Select all the acceptable spouse marital status from the following:

            Single      Divorced       Widow        With Children


Select the least acceptable spouse educational level from the following:

     Less than High School      High School       College Degree


In addition to the above, provide a brief description of your requirements of spouse:

  References:  Please provide two references:

 Name:          Tel: 

 Name:           Tel: 

If you are an applicant, please skip the following Agent Section (3 input fields):

For Agent Only:  Kindly input your name:

For Agent Only:  Agent Number

For Agent Only:  Agent Applicant Number

Kindly review your input before submitting.  After clicking on Submit Form below, the screen will show your input. To ensure that your input has been registered, call us after 24 hours of submitting your form.  Jazaka Allah Khayrun Katherun

 Wa Assalamu Aliakum Wa-Rahmatullahi Wa-Barakatuh!

Abo-Ahmad (626) 462-9117








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