MENTOR COUPLE - Marriage Bio

MENTOR COUPLE - Marriage Bio

Please fill out this form together with your spouse if you would like to serve as a mentor to another couple.
Contact Info
Names*

First Name & First NameLast Name(s)
Email Address(es)*
Preferred Phone*

Area CodePhone Number
Alternate Phone

Area CodePhone Number
General Info
Wedding Anniversary

MonthDayYear
How long were you together before you were married?*
Have either of you been previously married?*
If you have children, what are their ages?
What are your occupations?*
Church Involvement (select all which apply)*

Church of the Rock - Winnipeg SouthChurch of the Rock - Bronx ParkChurch of the Rock - NivervilleChurch of the Rock - North EndChurch of the Rock - Onlinewe are part of a Home GroupOther
Why are you interested in mentoring?*
More About Each of You

Please complete the following questions as individuals.
1. How would you rate your spiritual life?

Husband - my spiritual life is...*

	1	2	3	4	5	6	7	8	9	10

1 is nonexistent, 10 is strong, healthy

Wife - my spiritual life is...*

	1	2	3	4	5	6	7	8	9	10

1 is nonexistent, 10 is strong, healthy

Husband - my level of satisfaction is...*

	1	2	3	4	5

1 is Low, 5 is Very high

Wife - my level of satisfaction is...*

	1	2	3	4	5

1 is Low, 5 is Very high

4. Please describe your marriage.
Husband's description *
Wife's description*
5. What will make you a particularly good marriage mentor? Note any skills, education, life experience, challenges you've overcome, etc.
Husband
Wife
6. We want to be wise and prayerful in matching mentor with mentee couples. To help with that process,
What are 3 things we should know about you?
Husband's interests, job, passions, quirks, hobbies...
Wife's interests, job, passions, quirks, hobbies...
Please advise of your age...
Husband's age*
Wife's age*
References
3 people who know you well as a couple:
1st Reference Name(s)
1st Contact Info:
2nd Reference Name(s)
2nd Contact Info:
3rd Reference Name(s)
3rd Contact Info:
Agreement
Do you both agree to attend a Mentor Orientation session?

YesNo
Do you both agree to be interviewed by Mentoring leaders?

YesNo
Please feel free to contact steve@churchoftherock.ca / 204.261.0070 if you have any additional questions.
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More About Each of You