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Marriage Mentoring Ministry Application for Men

Please fill out the below questions and submit. Someone from the Marriage Mentoring Ministry will contact you upon completion of your questionnaires and receipt of online payment (separate payment link on previous page). Note, scholarships can be considered if there is a financial hardship. Please email marriagementoring@burnthickory.com to discuss.

*Address Line 1
Address Line 2
*City
*State/Province/Region
*Zip/Postal Code
*I am a:
*Age:
*BHBC status:
If you reg attend BHBC are you active in a LifeGroup?
If so, what LifeGroup?
If not a reg attender/member of BHBC, do you regularly attend another church?
If so, what church?
*Why do you want to be mentored?
For Premarital Only
How long have you known each other?
How long have you been dating?
How long have you officially been engaged?
What is your tentative wedding date?
Where will your wedding be?
More about you
Occupation:
Hobbies:
Pet Peeves:
Strengths:
Weaknesses:
*Check the answer that best describes you:
Marital Status (skip if not married yet)
How long have you been married to your current spouse?
Have you been previously married?
If yes, how many times?
How long were you married before?
When was the divorce final?
What was the reason for the divorce?
Did you try to reconcile?
Who initiated the filing?
Did your spouse commit adultery?
Did you commit adultery?
Were you a christian at the time?
Was your spouse a christian?
Do you have children from your current and or past marriages?
If so, include their names and ages and whether they are from your current marriage or a past (if applicable):
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 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 sessions or any time thereafter. I understand that the Mentor Couple can discontinue the mentoring at any time and that the fees paid for mentoring are nonrefundable.
*I accept and release any liability on behalf of Dare to be Different Ministries and BHBC.:
Submit Form