Marriage Mentee Application

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We are so glad you are interested in being matched with a marriage mentor couple who will commit to walk alongside you in your marriage. Please complete this brief form so we can make the best match possible for you. Thank you!

Email *

First Name *

Spouse's First Name *

Last Name *

Address

Phone Number *

Wedding Anniversary

YYYY

Option 1

Clear selection

Do you have Children?

Yes

Clear selection

If yes, what are their names and ages?

Which of the following is the reason for seeking a marriage mentor couple? *

Preparing for Marriage -Building a solid foundation (newlywed or engaged)

Maximizing your Marriage- Deepening and enriching stable marriages

Repairing your Marriage- Encouragement for couples in distress

We desire to match you with a mentor couple with whom you have some similarities.

Please check all of the following that apply.

We married later in life (35 years or older)

We married young (under 25 years of age)

This is a second marriage

We have a large family

We have a blended family

We have a special needs child

We have adopted children

We have experienced the loss of a child

We have experienced infertility

We now have an empty nest

We are dealing with the challenge of long work hours

We both work outside the home

We have a demanding travel schedule

We have difficult in-laws

We want to learn how to have healthy conflict resolution

We want to learn healthy ways to communicate

We are looking for ways to navigate through unemployment

We are dealing with a serious illness

We have experienced unfaithfulness

We are experiencing a financial crisis

We want to prevent any addiction

We need healing from a past porn addiction

We want to improve our sex life

We want to do challenging adventures together

We want to pursue and enjoy the same types of activities together

We have a difficult family of origin issue

We have different faith backgrounds

Other:

Required

Do you have any unusual scheduling issues that may impact when you can meet with your mentors?

Please feel free to write any additional comments that would help us match you with a mentor couple.

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