Mentee Application Form

His

First Name

Last Name

Phone

Email Address

Street Address

City

Postcode

Hers

First Name

Last Name

Phone

Email Address

Street Address

City

Postcode

Wedding anniversary

Children? (If yes, please provide gender/age)

Please provide child gender/age

Gender *

Age *

For which category are you seeking a marriage mentor couple?Preparing Marriages - Building solid foundations for engaged and newlywed couplesMaximising Marriages - Deepening and enriching stable marriagesRestoring Marriages - Encouraging couples in distress

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

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

Here at Jesus House we take your privacy seriously and will only use your personal information to administer your membership in this program and provide the products and services you have requested from us. For a full statement of the use of your data by Jesus House please see www.jesushouse.org.uk/privacy.’ However, from time to time we would like to contact you with details of other events, ministries and services we provide. If you consent to us contacting you for this purpose. Please tick how you would like us to contact you:PostEmailTelephoneText

Data Protection Statement

We seek to comply with the Data Protection Act of 1998 and take all reasonable care to prevent any unauthorized access to your personal data. The information you have provided is intended for use only by Jesus House and will not be disclosed to any third party without your consent. We use personal information for administrative purposes and to support, improve and obtain feedback on our service to you.

JH Marriage Mentoring Mentee Application Form