Marriage Mentor Application

MARRIAGE MENTOR APPLICATION
Last Name (Husband):
First Name (Husband):
E-mail (Husband):
Last Name (Wife):
First Name (Wife):
E-mail (Wife):
Wedding Anniversary:
Children:
 Yes
 No
If Yes, please provide gender/age for each child:
Do you believe in Jesus Christ as your Lord and Savior?
Husband:
 Yes
 No
Wife
 Yes
 No
In which one of these categories are you interested in being Marriage Mentors?
 Prepared Marriages
 Maximizing Marriages
Check all statements below that are true for your marriage history that will help us match you with a couple:
 We married late in life (35 years or older)
 We married young (under 20 years of age)
 This is a second marriage
 We had a baby before we married
 We have a large family (4+ children)
 We have a special-needs child
 We have experienced the loss of a child
 We have experienced infertility
 We have dealt with the challenge of long work hours
 We both work outside of the home
 We have learned how to stay connected despite a demanding travel schedule
 We have experience with difficult in-laws
 We are especially practiced at conflict resolution
 We have had to learn healthy ways to communicate
 We have navigated through an employment crisis
 We have pulled through a serious illness
 We have experienced unfaithfulness and forgiveness
 We have gone through a financial crisis together
 We have learned the benefit of having a financial budget
 We have experienced recovery from an addiction
 We have learned the importance of keeping our sex life happy
 We especially enjoy doing challenging adventures together
 We have found ways to enjoy the same types of activities together
 One of us has found healing from a difficult family of origin issue
 We have come from a different faith background
 We were raised with different cultural backgrounds
Other:
If you have experienced an impactful crisis that you are comfortable sharing, please describe the issue and how you dealt with it:
Are any of the Red Flag Statements below true for you? If so, this may not be the best time for you to invest in the lives of others. All marriages go through hurdles from time to time. We would encourage you to first, address the issue in your own marriage; and then use your story to mentor others. (I Corinthians 1:4)
This is just a list for you to go over - do not check any that apply:
 You are currently battling any kind of addiction (gambling, pornography, drugs, alcohol, etc.)
 You have uncontrollable emotional outbursts that you have not yet managed
 You have recently suffered a significant setback (financial, emotional, etc.)
 Your marriage is not stable or is fraught with frequent conflict
 You have suffered serious emotional wounds from some kind of abuse in your life and you are still trying to find healing
 You are struggling with significant financial debt
 One of you is far more motivated to become a marriage mentor than the other
 You do not have a sense of meaning and purpose in your life
 You are pessimistic about marriage in general
 You avoid personal responsibility for problems in your life
 You are not content and at peace with your life and your marriage
 You are not living your life by submitting to Biblical principles
 You are primarily motivated to be marriage mentors to help your own marriage
 You have been told by others that you may not be in a good place to be marriage mentors right now
According to the Red Flag Statements above, we are in a good place to be effective Marriage Mentors.
Husband:
 Yes
 No
Wife:
 Yes
 No


Submit

UA-84469273-1 UA-84525700-1