Marriage Mentee Couple Application

Your name *

Email address *

Phone number *

Address *

Spouse Phone Number *

Are you a follower of Jesus? *

We both are.

Husband, not wife.

Wife, not husband.

Do you attend weekend services at Chapel Pointe? *

Yes(2+ times a month)

Occasionally(1 or less times a month)

No(We do not attend Chapel Pointe)

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

Example: Sunday, Tuesday, Friday

Any children? Please list names, ages, and gender.

Previously married? *

Yes

How would you rate your marriage? *

1 = NOT happy, 10 = VERY happy

In specific terms, what are you hoping that a marriage mentor couple will help you accomplish? *

Have you and your spouse talked about and agree that marriage mentoring is what you would like to do? *

Yes

Yes, but not totally on the same page.

Yes, had a brief, initial conversation.

No, we have not, but we agree we need some help.

No, I'm just reaching out and hoping my spouse will agree.

Please list any area of serious conflict that would be important for us to know before assigning you to a mentor couple.

Have you received counseling/pastoral care before? *

Yes

By checking the box below, we affirm that we have read and understand Chapel Pointe's Marriage Mentoring Confidentiality Statement(see below). *

Premarital mentors are godly men and women who have been married for at least four years. They are committed to God and to each other. They are not professionals in psychological counseling or psychiatric therapy and are not licensed. If the mentors discover issues that they are not trained to handle, you may be referred to the Marriage and Counseling Pastor or a professional counselor. All communication between you and your mentors is considered confidential, except as 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). The mentors will also be receiving supervision from trained professionals.