Marriage or Pre-Marital Mentoring Request

Mr.
Miss/Mrs.
Contact Information

(Use space on bottom of back page if different addresses)
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone: ### - ### - ####
His Email
Her Email
Marriage Details
Anniversary/Wedding date MM / DD / YYYY
Husband, have you ever been divorced?
Yes No
Wife, have you ever been divorced?
Yes No
Children?
Yes No
If yes, from
Both Husband only Wife only

Marriage Matters® Mentoree Agreement

We, and , 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.
Agreement Sign Date MM / DD / YYYY
His Interests
Occupation
Hobbies
Pet Peeves
Strengths
Weaknesses
Describe your Dream Vacation
If you had 8 hours to yourself, how would you spend it?
Birth year
Her Interests
Occupation
Hobbies
Pet Peeves
Strengths
Weaknesses
Describe your Dream Vacation
If you had 8 hours to yourself, how would you spend it?
Birth year
How did you hear about Marriage Mentoring?
Why do you want to be mentored?
Do Not Fill This Out