ISLAMIC EDUCATION CENTER – Houston, Texas

Matrimonial Profile Questionnaire - STRICTLY CONFIDENTIAL

Please read important information on the back of this form.

Gender: ○ Male ○ Female

Name: Family ______First ______Middle ______

Date & Place of Birth: (MM/DD/Yr) ______Place ______

Current resident address: ______

______

Contact: Telephone: ______E-mail: ______

Personal Features: Height ______

Where do your parents currently live? ______

No of siblings: Brothers ______Sisters ______

Education Level: ○ Graduate ○ College ○ High School ○ Vocational

Current Occupation & Employment: ______

Do you plan to pursue further education? ○ Yes ○ No

Are you willing to relocate? ○ Yes ○ No

Your key hobbies or areas of interest:

1.  ______

2.  ______

3.  ______

4.  ______

Characteristics that you would like to see in your potential spouse.

  1. ______
  2. ______
  3. ______

Preferences and restrictions that you want us to be aware:

  1. ______
  2. ______
  3. ______
  4. ______
  5. ______

Optional Attachments: ○ Pictures ○ Additional Information

Parent/Guardian Name: ______

Address: ______

Contact: Telephone ______E-mail ______

Primary Person to Contact: ○ parent/guardian ○ candidate

Best time to contact: ______


IEC and the Matrimonial Subcommittee are acting in the role of a facilitator to match potential partners for the purposes of permanent marriage. The final decisions will be the sole responsibility of the candidates and their parents/guardian. The parties agree not to hold the IEC, its Board of Directors or any of its subcommittees responsible for any unexpected consequences from a potential marriage.

I/We have read, understand and agree the above.

Signatures: ______

Candidate Parent/Guardian

Date: ______

ALL INFORMATION PROVIDED WILL BE HELD IN STRICT CONFIDENCE AND BE ACCESSIBLE TO MEMBERS OF THE MATRIMONIAL SUB-COMMITTEE ONLY.

Notes:

1.  The Matrimonial Sub-committee (MSC) is established under the auspices of the Board of Directors of the Islamic Education Center of Houston, Texas.

2.  The primary objective of the MSC is to facilitate the marriage of couples within the Muslim Shia community in the greater Houston area.

3.  The MSC consists of a maximum of 4 persons that are appointed by the IEC Board.

4.  The MSC is fully committed to coordinate these activities under strict confidentiality. Only the MSC members will have access to the profiles of the candidates.

5.  The MSC will also work with other Shia community groups within the USA and Canada.

6.  A member of the MSC will be assigned as a primary contact and will coordinate all matters in each case.