Marriage Ministry

Marriage Mentoring Information Survey

The purpose of this survey is to gain some background information to help in matching marriage mentors with mentoree couples. If some items do not apply to you, please so indicate. If you are engaged, please answer as if married, as appropriate. Thank you for providing this information.

* - All fields required.

Marriage Mentoring Information

Contact Information

Today's Date: (mm/dd/yyyy)
Name(s):
Address:
City:
State
Zip Code:
Phone No.: (Primary)
Other Phone No.:
Anniversary Date: (mm/dd/yyyy)

Where were you married?

City:
State:
How long did you date before marriage - including engagement?
How did you meet?

	Husband	Wife
Where were you born?
Where did you grow up?
Did you attend church growing up?
Were your parents together when you got married?(If not, please state why – e.g. death, divorce)
What is your education background (level and areas of study)?
What is your occupation (including homemaker)?
How old were you when you became a Christian?
What are your hobbies?
What ages were you when you got married?

Siblings

Do you have siblings and if so, how many brothers and sisters and where are you in the birth order?

	Brothers	Sisters	My place in the order
Husband
Wife

Children

Do you have children and if so, how many boys, girls, and ages of each?

	Number	Ages (comma separate)
Boys
Girls

What do you enjoy doing as a couple?
In what area(s) do you desire to grow as a couple?
What other information do you feel would help us to match you with another couple?

Prior Marriages

	Husband	Wife
Have you been married before?
How and when did the marriage end?
Were there children? List ages now.

* - All fields required.

Providence Baptist Church
6339 Glenwood Avenue
Raleigh, NC 27612

phone: (919) 326-3000

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Marriage Mentoring Information Survey

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