Masjidullah Center for Human Excellence Membership Form Question Title * 1. What is your full name? First Middle Last Question Title * 2. How can you be contacted? Street Address: City/State/Zip Code Home Phone: Cell Phone: Email Address: Question Title * 3. What is your Date of Birth? Date / Time Question Title * 4. What is your gender? Female Male Question Title * 5. Marital Status: Married Divorced/Widowed Single Question Title * 6. Names and birth date of household family members: Spouse Child 1 Child 2 Child 3 Child 4 Other Relative Question Title * 7. Employer name: Question Title * 8. What is the highest level of education you have completed? Did not attend school 1st grade 2nd grade 3rd grade 4th grade 5th grade 6th grade 7th grade 8th grade 9th grade 10th grade 11th grade Graduated from high school 1 year of college 2 years of college 3 years of college Graduated from college Some graduate school Completed graduate school Question Title * 9. Islamic Community Involvement/Interests: (Select all that interest you.) Administrative Information Services Bookstore Arbitration Building Maintenance By-Laws Committee Collective Buying Community Development Cultural Development Dawah Committee Educational Development Hajj Committee Health & Human Services Imam's Staff Janazah Committee Jewels of Islam Madressa Staff Membership/New Shahadah Committee Nominating Committee Political Action Committee Public Relations Safety & Security Secretary's Staff Youth Committee Other Done