M3 Mentee Application Form

Household members

Address

Phone number

Birthdate

Spouses Name/Birthdate

Marital status

What campus do you attend? *

How long have you been married?

For which category are you seeking a marriage mentor couple? *

What are your desired outcomes from the mentoring program? *

Do you have any previous experience with counseling or mentoring? If yes, please explain.

Do you have any unusual scheduling issues that may impact when you can meet with your mentors?

Please click all statements below that are true for your marriage history that will help to match you with a mentor couple *

We married late in life (35 years or older)

We married young (under 20 years of age)

This is a second marriage

We have a large family (4 or more children)

We have a special-needs child

We have experienced the loss of a child

We have experienced infertility

We are dealing with the challenge of long work hours

We both work outside the home

We have a demanding travel schedule

We have difficult in-laws

We want to learn how to have healthy conflict resolution

We want to learn healthy ways to communicate

We are looking for ways to navigate through unemployment

We are dealing with a serious illness

We have experienced unfaithfulness

We are experiencing a financial crisis

We want to prevent any addiction

We want to improve our sex life

We want to do challenging adventures together

We want to pursue and enjoy the same types of activities together

We have a difficult family of origin issue

We have different faith backgrounds

We were raised with different cultural backgrounds

Other

Please feel free to write any additional comments that would help us match you with a mentor couple