REVERT
MUSLIM ASSOC. & THE PATH OF LIGHT - MARRIAGE Application
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Applicant
Information
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Family
Name:
First Name:
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Date
of birth:
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Age:
Height:
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Male:
M
Female:
F
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Address:
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Apt
/ Unit / Suite:
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City:
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Province/
State:
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Postal
/ ZIP Code:
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Phone:
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Email:
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Ethnicity:
Country of Birth:
Citizenship:
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Spoken
Languages:
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Mother
Tongue:
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Marital
Status: Please check one: Single
– Never Married: ______
Divorced: _______
Separated: _________
Widowed: _________
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Do
you have children? If so, how many: 1
2
3 4
5
Their Age(s):
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School
of Thought:
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Revert
/ Born Muslim:
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Reverted
– How long?
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PROFESSIONAL
ACCOMPLISHMENTS / INTERESTS
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Education
– Completed:
___ High
School ___
College ___ University (Bachelor)
___ University (Master’s)
____ University (Ph.D.)
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Current
Status:
Student ____
Employed _____
Self-Employed ____
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Profession:
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Future
Goals:
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Interests
/ Hobbies:
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SPOUSAL
CRITERIA
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Please
state the most important qualities that you are seeking in a
mate. In
addition, advise us if you are willing to marry outside of
your cultural background.
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REFERENCES
- Please state the reference’s relationship to you beside
their name
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Name
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Email:
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Phone
– Area Code + Number
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Please
provide three personal references and one professional
reference, if you are employed.
If possible, please provide the reference of a Sheikh,
Maulana or Alim from an existing Islamic Center.
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provide additional
information THAT MAY ASSIST US IN FINDING A SUITABLE MATE FOR
YOU.
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DISCLAIMER: Please be advised that, Revert Muslim Association (RMA) and
The Canadian Islamic Center of Montreal (Path of Light) are
solely providing an “Introduction” service to all
applicants. RMA and CICM will not bear responsibility for the
outcome of said “Introductions”.
All applicants are to assume responsibility for the
verification of the references provided on the applicant’s
form. RMA and CICM strongly suggest that applicants enlist the
support / involvement of family and friends during this
process (particularly females).
It is highly recommended that each applicant inform
themselves about the Islamic laws related to marriage and the
roles & responsibilities of each gender.
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I,
hereby declare that all the information contained within this
application is correct. I have read the disclaimer and
understand that Revert Muslim Association / Canadian Islamic
Center of Montreal (Path of Light) is only providing a service
to introduce single, practicing Muslims and bear no
responsibility for the outcomes thereof.
Signature
of applicant:
___________________________________________________________
Date: ___________________________________
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