The information on this form will help us match you with a couple who have similar history and/or life events.  The information on this form is strictly confidential and will be emailed directly to the Couple-to-Couple Ministry leader when you click on the "Submit" button below.  It will not be shared with anyone without your express permission.

Name *
First Name
Middle
Last Name
Spouse Name *
First Name
Middle
Last Name
Address *
Address Line 1
Address Line 2
City
State
Postal Code
Phone*
Email*
How many years married?*
If engaged, when is wedding date?
Any prior marriages for husband?*
Any prior marriages for wife?*
w long have you been attending CACC?*
Husband's Employment:*
Wife's Employment:*
If children, ages:
Number of children at home *
What are you actively involved in at CACC? (please specify husband and/or wife) *
What major life experiences (such as divorce, bankruptcy, job loss, death of a child, etc.) have you dealt with, either as a couple or indivually? *
All couples have areas of strength and areas in which they would like to grow. Consider the topics below and select three in which you would like to improve as a couple.
Please provide relavant information about the husband's and wife's family history with respect to marriage.
Do you have any questions about marriage mentoring?
*