Matrimonial Services

Madina Masjid offers matrimonial services that range from Nikah services to pre – Nikah counseling for couples in a private confidential manner. You can call or contact the masjid at (888) 123-4567 Or Contact us Via email

Matrimonial Form


Phone Number

Parents Name

Parents Phone Number

Number of Siblings
Have you been previously married?

Do you have any children
Shi'a or Sunni

Which Masjid are you currently affiliated with?
What Languages do you speak (List All)?

If not born in the USA, how long have you lived in the USA?

Willing to Relocate?

Age Preference

What are the main characteristics that you wish to see in a spouse
How religious do you think you are from 1-10 (1 is not at all religious and 10 being scholarly)?

How religious do you wish for your spouse to be from 1-10 (1 is not at all religious and 10 being scholarly)?
Do you wear the Hijab/would you expect your spouse to wear the hijab?

Is there anyone in your family living with you now?
Are you planning to have anyone in your family live with you in the future?

Do you support the idea of a working wife?
Would you be willing to share your photograph with prospects?

Please feel free to share any additional details that will help us

All personal information will be used only for the purposes of protecting the Masjid and will not be shared or sold in any way.
A $50 registration fee will be required, in the way of a donation to the Masjid to ensure that you are serious about this process.
A $500 donation to the Masjid is recommended if this process leads to a successful Nikah with the person that is introduced to you via this process.
The Imam, ICCT and the members of this committee are in no way responsible emotionally, financially or otherwise if this Nikah does not remain successful in the future.
By checking this off you understand that you have read and understood the disclaimers listed above.