Marriage Mentor Application

This form is to be completed by each person in a couple.

Your name *

Email address *

Address

Phone number

Wedding Anniversary (including year) *

Children? *

Yes

If yes, please provide ages and gender

Other

Age/ Gender of Children

Previously married?

Yes

If yes, please explain.

How motivated are you to become a marriage mentor? (1-very little, 10-Very much)

min: 1 / max: 10

Why do you want to be a marriage mentor?

Under which of these categories are you interested in being a marriage mentor?

Preparing for Marriage (1- Very little, 10- Very much)

min: 1 / max: 10

Maximizing Marriages (1- Very little, 10- Very much)

min: 1 / max: 10

Repairing Marriages (1- Very little, 10- Very much)

min: 1 / max: 10

What concerns or fears do you have about becoming a marriage mentor?

Are you willing to participate in some training to become a marriage mentor?

How would you rate your marriage? (1-Not happy, 10- Very happy)

min: 1 / max: 10

What would make you a particularly good marriage mentor (note any skills, education, life experience, challenges you've overcome, etc.)?

Please describe the most outstanding crisis you have experienced as a couple and how you dealt with it.

How would you rate your individual spiritual life (i.e., your relationship with God)? (1-Nonexistent, 10- Strong)

min: 1 / max: 10

Please provide your Christian testimony:

If you are not selected to be a marriage mentor at this time, are you willing to be considered again later?

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