Marriage Mentoring Application Marriage Mentoring Application Each spouse must completely this form separately. Who is filling this form out right now? * Husband Wife Your Email * Husband's Name * First Last * Last Wife's Name * First Last * Last Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Husband's Phone * Wife's Phone * His Occupation * Her Occupation * Husband's Birth Date * Wife's Birth Date * Wedding Anniversary Why are you requesting marriage mentoring? * Our marriage is good but could use some improvement Our marriage is struggling and in need of help Our marriage is in crisis, and we are in need of urgent help Premarital Have either of you been married before? * Wife: YesHusband: YesBothNo Are there children involved? If so, please list their names and which spouse they belong to * Do you attend First Christian Church? * YesNo If you attend another church, where do you attend? Check the answer that best describes your faith life * New Christian Established Christian Seeker: Curious but wouldn't say I'm a Christian Without religious belief More About You Hobbies Pet Peeves Strengths Weaknesses Mentoree Agreement I understand that the Mentor Couple we meet with are not professional counselors, but volunteer marriage mentors who agree to share their life experiences with us in an effort to help us strengthen our marriage. I understand that we are responsible for the success of our own marriage throughout the mentoring sessions or any time thereafter. I will allow Dare to be Different and the First Christian Church leaders to access our personal information which will be kept confidential. I acknowledge that by submitting this form to First Christian Church constitutes my agreement to these terms. * Yes No Submit If you are human, leave this field blank. Δ
