Marriage Mentoring Request Form
This information will help us get a better grasp of how to help come alongside you. Please write only what you feel comfortable sharing.
Husband's First Name *
Husband's Last Name *
Wife's First Name *
Wife's Last Name *
Husband's Email *
Wife's Email *
Husband's Phone *
Wife's Phone *
Preferred method of contact *
Husband's Age *
Wife's Age *
How many years have you been married? *
Are you: *
Are you in a Community Group (CG)? *
If you are in a Community Group, who are your leaders?
Any children? Please list names, ages, and gender (if applicable). *
Have either of you been previously married? *
Briefly describe why you are seeking marriage mentoring: *
In specific terms, what are you hoping that a marriage mentor couple will help you accomplish? *
Please list any area of serious conflict that would be important for us to know before assigning you to a mentor couple. *
Have you received counseling/pastoral care as a couple before? *
If there's anything else you think we should know, please write that here:
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