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EFCCL Marriage Assessment Application
Email address *
Name:
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Spouse's name:
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Phone number
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Best way to contact you:
Are you willing to attend every week of this workshop?
Do you regularly attend church and, if so, where do you attend?
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How long have you been married?
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Number of children and their ages:
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Have you been previously married?
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Number of children and their ages from previous marriage(s):
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Describe any prior marriage mentoring, workshops or counseling:
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FAMILY BACKGROUND/HISTORY
What are the strengths and weaknesses of the family in which you were raised?
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What do you perceive to be the strengths and weaknesses of your spouse's family?
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Was there any alcohol, drug, physical or sexual abuse in your family background? If so, how have these experiences influenced you?
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How does the influence of your family background affect your marriage??
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Have you personally struggled with alcohol, drugs, pornography or other addictions?
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Has your spouse struggled with alcohol, drugs, pornography or other addictions?
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SPIRITUALITY
How do you best describe your relationship with Jesus Christ?
How do you perceive your spouse's relationship with Jesus Christ?
INTIMACY
On a scale of 1 to 10 (1=very weak 10=very strong) rank your perceived level of physical intimacy - which is most associated with sexual intercourse but also includes non-sexual touching, holding hands, hugs, etc.. Make a short statement as to your ranking.
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On a scale of 1 to 10 (1=very weak 10=very strong) rank your perceived level of verbal intimacy - which is most associated with self-disclosure including the sharing of thoughts, ideas and suggestions. Make a short statement as to your ranking.
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On a scale of 1 to 10 (1 = very weak 10 = very strong) rank your perceived level of emotional intimacy - which is sharing both positive and negative emotions, being comfortable sharing fears and worries as well as happy times with each other. Make a short statement as to your ranking.
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On a scale of 1 to 10 (1 = very weak 10 = very strong) rank your perceived level of intellectual intimacy - which involves sharing mutual interests that you enjoy doing together. Make a short statement as to your ranking.
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On a scale of 1 to 10 (1 = very weak 10 = very strong) rank your perceived level of psychological intimacy - which includes honesty, truthfulness, loyalty and commitment. Make a short statement as to your ranking.
Your answer
On a scale of 1 to 10 (1 = very weak 10 = very strong) rank your perceived level of spiritual intimacy - which includes attending church together, praying together, reading and studying scripture together. Make a short statement as to your ranking.
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Describe how you express emotional pain, disagreement and anger in your relationship:
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SUMMARY
What do you feel are your best qualities?
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What would you say are the best qualities in your spouse?
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What do you feel are qualities in yourself that are in need of growth?
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What would you say are qualities in your spouse that have room for growth?
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If you could change three things about your marriage what would they be?
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What current events or situations do you feel have negatively impacted your marriage?
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On a scale of 1 to 5 (1 = very broken to 5 = thriving) marriage, how would you rate the current state of your marriage?
Describe the things you can take ownership of for the current state of your marriage:
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