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Login Information

Username *

Email *

Password *

Personal Information

Husband's Details

First Name *

Last Name *

Age *

Nationality *

Race *

Christian Denomination *

Contact Number *

Email Address *

Wife's Details

First Name *

Last Name *

Age *

Nationality *

Race *

Christian Denomination *

Contact Number *

Email Address *

Mailing Address

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Marriage Background

How long have you been married? *

You have to be married for 10 years to be a mentor.

Do you have children? *YesNo

If so, please list their ages:

Age *

Are you active members of a church? *YesNo

If so, please provide the name of your church. *

Faith and Marital Experience

Briefly describe your faith journeys and how they have shaped your marriage: *

How would you describe the role of “Christ-Centeredness” in your marriage? *

What are some challenges you have overcome as a couple that you feel would help you guide and support mentees? *

Goals for Mentoring

Why do you want to serve as a mentor couple in this program? *

What problems (if any) do you anticipate during your time as a volunteer mentor in this program? *

Please indicate if anything (such as moral flaws) could make it difficult for you to be an effective mentor: *

Availability and Preferences

Preferred Frequency of Mentoring Sessions: *WeeklyBiweeklyMonthly (Required)Other

Please specify *

Preferred Meeting Format *In-personVirtualNo preference

Are there any days or times that work best for you? *

Agreement and Commitment

As a mentor couple, we agree to: *Uphold a respectful, non-judgmental, and Christ-centered environment for our mentees.

Approach our mentoring role with humility, confidentiality, and open communication.

Serve voluntarily and understand that our role is to offer guidance and encouragement, not professional counseling.

Please check to confirm: *We understand that we are volunteering as mentors and agree not to hold the mentoring program or its participants liable for any outcomes of the mentoring relationship.

We agree to commit our time and effort to support our mentee couple(s) as they grow in their marriage and faith.

Additional Information

Is there anything else you would like us to know about your background or experience that may help in pairing you with a mentee couple? *YesNo

Please let us know *

Signatures

Husband's Signature:

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Date *

Wife's Signature:

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Date *

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