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Marriage & Pre-Marriage Mentoring Request

*Address Line 1
Address Line 2
*City
*State/Province/Region
*Zip/Postal Code
*Which type of mentoring are you looking for?
GENERAL INFORMATION
*Husband's Name:
*Husband's Age:
*Husband Phone:
*Can you receive texts?
*Husband's Email:
*Wife's Name:
*Wife's Age:
*Wife's Phone:
*Can you receive texts?
*Wife's Email:
*Are you Member(s)/Regular Attender(s) at MVCC?
How long have you attended MVCC?
Do you attend another church?
What church do you attend?
*Please share about your faith. (Husband)
*Please share about your faith. (Wife)
MARITAL INFORMATION
*How long did you date before getting married?
*Engagement Date:
*Wedding Date:
*Are you currently living together?
*If married, how long have you been married?
*Have you been previously married? (Husband)
How many times, and for how long?
Reason(s) why previous marriage(s) ended?
*Have you been previously married? (Wife)
How many times, and for how long?
Reason(s) why previous marriage(s) ended?
FAMILY INFORMATION
*Do you have children?  If yes, please list children and fill out the following information.
1. Child Name:
Age:
Familial Relationship 
2. Child Name:
Age:
Familial Relationship:
3. Child Name:
Age:
Familial Relationship:
4. Child Name:
Age:
Familial Relationship:
5. Child Name:
Age:
Familial Relationship:
6. Child Name:
Age: 
Familial Relationship:
7. Child Name:
Age: 
Familial Relationship:
*What effect has children had on your relationship?
*What are you currently struggling with in your relationship?
*What is the hardest thing you've had to deal with in your relationship and how did you deal with it?
*What, if any, types of resources (i.e. counseling, books, conferences) have you utilized to strengthen your relationship?
*Why do you want to be mentored?
*Are there any physical or mental health issues that we should be aware of? (Y/N  If yes, please explain)
*Is there anything special we should know about you to better meet your needs?
*What days and times of the week would you be available to meet?  Any specific scheduling issues that need to be considered?
MENTEE AGREEMENT
We 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.  We understand that we are responsible for the success of our own marriage, and we do not hold our Mentor Couple responsible for the state of our marriage throughout the mentoring sessions or any time thereafter.  We understand that the information shared in this application and during the marriage mentoring sessions will be kept confidential between the Mountain View Community Church Marriage Mentor and the Mountain View Community Church Pastors.
*Please acknowledge your agreement here.
Please note that there is a cost of $35 for the Prepare and Enrich assessment that is paid on their website.
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