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IACC matrimonial intake form
PERSONAL INFORMATION
RELEVANT INFORMATION
REVIEW
FINISH
PERSONAL INFORMATION:
Step 1 - 4
Full Name:
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Current City:
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Current State:
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Select State
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Utah (UT)
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Virgin Islands of the U.S. (VI)
Virginia (VA)
Washington (WA)
West Virginia (WV)
Wisconsin (WI)
Wyoming (WY)
Phone:
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Email (user name):
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Password:
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Confirm Password:
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Year of Birth:
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Select Year of Birth
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
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1982
1983
1984
1985
1986
1987
1988
1989
1990
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1993
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1995
1996
1997
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1999
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2005
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2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
Age:
*
Gender:
*
Select Gender
Male
Female
Height:
*
Highest degree achieved:
*
Current profession:
*
Spoken language(s):
*
Legal Status:
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Select Legal Status
US Citizen
Green Card
F-1
OPT
H-1
B-1
J-1
Others
Country Of Origin:
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Select Country Of Origin
United States
Canada
United Kingdom
Afghanistan
Albania
Algeria
American Samoa
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands')
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-bissau
Guyana
Haiti
Heard and Mc Donald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea
Korea, Democratic People's Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Andorra
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands Antilles
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia (Slovak Republic)
Slovenia
Solomon Islands
Somalia
Bosnia and Herzegowina
South Africa
South Georgia & South Sandwich Islands
Spain
Sri Lanka
St. Helena
St. Pierre and Miquelon
Sudan
Suriname
Reunion
Svalbard and Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United States minor outlying islands
Uruguay
Uzbekistan
Vanuatu
Vatican City State (Holy See)
Venezuela
Viet Nam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna Islands
Western Sahara
Yemen
Zambia
Zimbabwe
Saudi Arabia
Marital Status:
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Select Marital Status
Never been married before
Widow
Divorced
Other
Religious view:
*
Select Religious view
Sunni
Shia
Other
Any kids?:
*
Select Option
Yes
No
Linkedin Profile Link:
Best Way To Reach:
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Willing to relocate?:
*
Select Option
Yes
No
Father:
*
Mother:
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Father's Country Of Origin:
*
Select Country Of Origin
United States
Canada
United Kingdom
Afghanistan
Albania
Algeria
American Samoa
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands')
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-bissau
Guyana
Haiti
Heard and Mc Donald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea
Korea, Democratic People's Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Andorra
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands Antilles
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia (Slovak Republic)
Slovenia
Solomon Islands
Somalia
Bosnia and Herzegowina
South Africa
South Georgia & South Sandwich Islands
Spain
Sri Lanka
St. Helena
St. Pierre and Miquelon
Sudan
Suriname
Reunion
Svalbard and Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United States minor outlying islands
Uruguay
Uzbekistan
Vanuatu
Vatican City State (Holy See)
Venezuela
Viet Nam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna Islands
Western Sahara
Yemen
Zambia
Zimbabwe
Saudi Arabia
Mother's Country Of Origin:
*
Select Country Of Origin
United States
Canada
United Kingdom
Afghanistan
Albania
Algeria
American Samoa
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands')
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-bissau
Guyana
Haiti
Heard and Mc Donald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea
Korea, Democratic People's Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Andorra
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands Antilles
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia (Slovak Republic)
Slovenia
Solomon Islands
Somalia
Bosnia and Herzegowina
South Africa
South Georgia & South Sandwich Islands
Spain
Sri Lanka
St. Helena
St. Pierre and Miquelon
Sudan
Suriname
Reunion
Svalbard and Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United States minor outlying islands
Uruguay
Uzbekistan
Vanuatu
Vatican City State (Holy See)
Venezuela
Viet Nam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna Islands
Western Sahara
Yemen
Zambia
Zimbabwe
Saudi Arabia
Number of Brother(s):
Number of Sisters(s):
Your Recent Photo
*
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RELEVANT INFORMATION:
Step 2 - 4
Current residence:
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Level Of Religiosity:
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Halal Acceptability[]:
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Marriage Role Expectation:
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Select Option
Traditional
Modern
Relationship With Your Family:
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Traits You Want To Improve:
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What Makes You a Good Partner:
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How Do U Handle Stress, Disagreement, Dispute:
*
How Do You Apologize And Like To Be Apologized:
*
Who Are You Financially Responsible For:
*
Any Loans Or Debts:
*
Any Health Issues:
*
Any bad habits (smoking, drinking, drugs):
*
3 Most Important Things About You:
*
SEEKING IN A SPOUSE
Preferred Ethnic Background:
*
Preferred Age:
*
Preferred Residence:
*
Preferred Highest Education:
*
Preferred Profession:
*
If previously married, is it a deal breaker:
*
If kids, is it a deal breaker:
*
Preferred Citizenship Status:
*
Preferred Religiosity Level:
*
Preferred Religious Affiliation:
*
3 Must Haves in Potential Spouse:
*
Would you attend a matrimonial event if organized by the masjid?
*
Yes
No
Maybe
Next
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PERSONAL INFORMATION:
Step 3 - 4
Full Name
City
State
Phone
Email
Gender
Year Of Birth
Height
Country of Origin
Marital Status
Any Kids
Religious view
Willing To Relocate
Best Way To Reach
Father
Mother
Father's Origin Country
Mother's Origin Country
Number of Brother(s)
Number of Sisters(s)
RELEVANT INFORMATION:
Current residence
Legal Status
Level Of Religiosity
Halal Acceptability[]
Marriage Role Expectation
Relationship With Your Family
Traits You Want To Improve
What Makes You a Good Partner
How Do You Apologize And Like To Be Apologized
Highest degree achieved
Current profession
Spoken language(s)
3 Must Haves in Potential Spouse
3 Most Important Things About You
How Do U Handle Stress, Disagreement, Dispute
Who Are You Financially Responsible For
Any Loans Or Debts
Any Health Issues
SEEKING IN A SPOUSE
Preferred Ethnic Background
Preferred Age
Preferred Highest Education
If previously married, is it a deal breaker
Preferred Citizenship Status
Preferred Residence
Preferred Profession
If kids, is it a deal breaker
Preferred Religiosity Level
Preferred Religious Affiliation
Would you attend a matrimonial event if organized by the masjid?
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REGISTRATION SUCCESS !
Thank You,
IACC Matrimonial Team
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