Marriage Mentoring Form (Wife) Marriage Mentorship WIFE form Name * Name First First Last Last Address * Address Address Address City City State AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State Zip Zip Phone * Email Age * Ethnic Origin * Highest Level of Education * Member/Regular Attender at Point Harbor * Yes No How long? * Are you attending another church? What is the church's name? * Why do you want to be mentored? * For Pre-Marital Only arrowup6 How long have you known each other? How long have you been dating? How long have you been officially engaged? What is your tentative wedding date? Where will the wedding be? More About You arrowup6 Occupation * Hobbies * Pet Peeves * Strengths * Weaknesses * Check the answer that best describes you * Seeker/Not yet a Christ follower New Christian Committed Christian Agnostic I'm not sure what I believe Marital Status arrowup6 How long have you been married to your current spouse? * Have you been previously married? * Yes No How many times? * How long were you married? * When was the divorce final? * What was the reason for divorce? * Did you try to reconcile? * Who filed for divorce? * Did your spouse commit adultery? * Did you commit adultery? * Were you a Christian at that time? * Was your spouse a Christian? * Children arrowup6 Do you have children? * Yes No Children's Info Name * Age * Parents * Both Wife only Husband only plus1 Add minus1 Remove Mentee Agreement * I understand that the Mentor Couple we meet with are not professional counselors, but rather marriage mentors who agree to help us strengthen our marriage. I understand that we are responsible for the success of our own marriage and do not hold our Mentor Couple, Point Harbor Church, or Dare to be Different responsible for the state of our marriage throughout the mentoring sessions or any time thereafter. I understand that the Mentor Couple can discontinue the mentoring at any time and that the fee paid for mentoring is nonrefundable. Signature Clear If you are human, leave this field blank. Submit
