Marriage Mentoring - Registration for Married Couples

Phone number *

Address *

Birthday *

Gender *

First & Last Name of Spouse *

CHURCH INVOLVEMENT

Are you a regular attendee of Anthem (attends two to three times per month)?

Do you currently serve at Anthem? *

Are you currently in a group? *

List the ways you and your spouse are alike. *

RELATIONSHIP DYNAMICS

How long have you known each other? *

List the ways you and your spouse are alike *

List the ways you and your spouse are different. *

List three strengths of your spouse. *

List three weaknesses of your spouse.

Would you classify your marriage as in crisis? *

PERSONAL BACKGROUND

Have you participated in professional counseling in the past? *

If so, how do you think it helped?

Do you have history of the any of the following?

Check all that apply.

Addiction

Domestic violence

Infidelity

Mental illness

Have you been married before? *

Do you have children? *

PERSONAL VIEWS

List three of your strengths. *

Describe some specific things about your spouse that concern you and that you would change if you could. *

List three of your weaknesses. *

FAMILY DYNAMICS

Does your family approve of your spouse? *

Are you well acquainted with your spouse's immediate family? *

What do you perceive to be the strengths of your spouse's family? *

What do you perceive to be the weaknesses of your spouse's family?

FAMILY BACKGROUND

How were love, warmth, and tenderness expressed in your home growing up? *

How well do you and your father communicate? *

How well do you and your mother communicate? *

Did your parents divorce? *

How has your family background affected your marriage? *

Has there been abuse in your family background?

Check all that apply.

Alcohol abuse

Drug abuse

Physical abuse

Sexual abuse

COMMUNICATION AND CONFLICT RESOLUTION

Describe how you make important decisions in your marriage? *

How important do you feel communication is to a relationship and how do you define it? *

How do you and your spouse express pain, disagreement, and anger in your relationship? *

EDUCATION AND EMPLOYMENT

What's your highest level of education? *

What was your degree/area of concentration?

Are you currently employed? *

FINANCIAL

Do you or your spouse currently have debt? *

Do you and your spouse have the same attitude toward giving/tithing? *

SOCIAL

What are two activities (recreational, social, etc.) that you and your spouse have in common? *

Do the two of you have mutual friends? *

How do people who know you best respond to this relationship? *

SPIRITUAL

Do you consider yourself a Christian? *

Is your spouse a Christian? *

What's your religious background? *

What would you like to see God do in your life? *

What would you like to see God do in your marriage? *

What would you like to see happen in your mentoring sessions? *

MENTORING EXPECTATIONS

Please list your top three preferences of days of the week to meet with your mentors. *

AGREEMENT

We affirm that we have read and understand the marriage mentoring confidentiality statement.

METHODS

Marriage mentors will be using an inventory called PREPARE/ENRICH, and reading materials as needed. PREPARE/ENRICH increases awareness or the strengths and growth areas of a couple, stimulates discussion of important issues, and teaches communication and conflict resolution skills. It is not intended to predict marital success and it is not to replace professional judgement.

MENTOR CREDENTIALS

Marriage mentors are godly men and women who have been married for at least five years. They are committed to God and to each other. They are not professionals in psychological counseling or psychiatric therapy and are not licensed. They have been trained in PREPARE/ENRICH. If the mentors discover issues that they are not trained to handle, you may be referred to a professional counselor.

CONFIDENTIALITY

All communication between you and your mentors is considered confidential, except required by law (i.e., where there is a threat of serious harm to self or others, as in the case of child abuse, suicide, or homicide).

Initials & Date *