February 9, 2004 - Tony Cooke



Marriage Application

General Information

Name: Birth Date:

Address: Age:

Phone: Business:

Marital Status:

_____Never Been Married Married Separated

_____Divorced Widowed

Occupation:

Years at current job:

Name and Address of Employer:

Education:

_____Last year completed Degree / Diploma

Major and minor (if college):

Other Training: Type

Number of Years

Military Service: Branch_____________________Rank

Number of Years_____________Type of Discharge

Special Training

Have you ever been arrested? _____Yes _____No

If yes, please explain:

Did someone refer you to this pastor or counselor? _____Yes _____No

If yes, give name and address of that person:

Why do you desire to engage in marriage preparation and perform your wedding ceremony?

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Financial:

Current Salary Predicted combined salary:

List your personal outstanding debts:

|Institution |Amount |

| | |

| | |

| | |

| | |

Are you planning to budget? Savings Account?

How long were you financially dependent on your parents?

Spiritual:

Have you ever had a Born-Again experience? When?

Do you attend church? Where?

How frequently? How Long?

Have you been Water Baptized? When?

Have you received the Baptism in the Holy Spirit?

Church activities?

Do you tithe?

Do you pray together? How Often?

Private devotional time?

Who takes the dominant role in spiritual matters?

Are you satisfied with your spiritual growth?

Page 2

Health Status

Describe your general health:

_____Very Good Good _____Average Poor

Describe all important present or past illnesses or handicaps:

When was your last physical exam? Results:

Have you ever been under treatment for emotional problems? Yes No

If yes, describe when, where, and under whose care:

List five goals you are reaching for in your lifetime:

1.

2.

3.

4.

5.

How do you hope to achieve these goals?

1.

2.

3.

4.

5.

What have you attempted to accomplish so far with your life?

Unsuccessful?

Page 3

Family History

List Family members, their ages, and marital status:

Father Name: Living or Deceased?

Occupation: Age:

Education: (highest grade completed):

Marital Status: Married Separated

Divorced Widowed

Marital History: Has your father ever been separated

Divorced or Widowed?

Mother Name: Living or Deceased?

Occupation: Age:

Education: (highest grade completed):

Marital Status: Married Separated

Divorced Widowed

Marital History: Has your mother ever been separated

Divorced or Widowed?

Description of Your Parents

How would you describe your relationship to your:

Father:

Mother:

In what ways do you want to be like your parents?

Your Father:

Your Mother:

Page 4

In what ways would you want to be different from your parents?

Your Father:

Your Mother:

Description of your Parents Relationship

Describe what you observed in the following areas of your parents relationship:

Friendship/Companionship:

General characteristics:

Frequency of being together:

Intensity of Relationship: (Competitive, combative, cool, casual, affectionate, romantic, etc.?)

Sexual Relationship: (Did you observe hugging, kissing, fondling, using endearing words, compliments, etc.?)

Decision-making/Leadership Roles: (Who led and in what ways?)

Religious Training in the Home: (Who trained and how?)

Management of Finances: (Who managed the money, what did they do with the money, and how successful were they in this task?)

What three qualities in your parents marriage would you like to duplicate in your

marriage?

1.

2.

3.

What three qualities in your parent’s marriage would you not like to duplicate in your marriage?

1.

2.

3.

Describe your relationship with your brothers and sisters during your childhood years:

Page 5

Describe any major marital crises in your parent’s marriage:

The conflict(s):

The reason for the conflict(s)

The resolution of the conflict(s)

Describe your feelings during this time:

Are you feeling differently now? Explain

Were there any chemical dependency problems (either drugs or alcohol) in your family?

(Parents, brothers, sisters) Yes No

If yes, how has that problem affected you?

Dating History

How did you meet?

How long have you known each other?

When did you become serious?

How long did you know each other before dating?

When did you start dating?

How long have you been engaged?

Date of engagement? Wedding date?

Did you date others prior to meeting your fiancé? Yes No

If yes, how many others have you dated? For how long?

Have you ever been engaged before?

If yes, did the prior engagement result in marriage? Yes No

If it did not, what ended the engagement?

Page 6

Will this be your first marriage? (If not, describe briefly the reason for its dissolution

and the time frame involved)

How would you describe your circle of friends prior to your engagement?

(i.e., “popular”, “wealthy”, “troublemaker”, “intellects”, etc.)

In what area of your relationship are you most compatible?

In what area of your relationship are you least compatible?

What area of your relationship could use the most improvement?

What is your favorite pastime together?

Individually?

Do you love one another?

If yes, what do you mean when you say “love” someone?

Answer the following questions as honestly as you possibly can:

(SA-Strongly Agree; A-Agree; U-Undecided; D-Disagree; SD- Strongly Disagree)

_____My fiancé is more intelligent than I

_____My fiancé understands people better than I

_____My fiancé is more outgoing than I

_____My fiancé is easily approachable to strangers

_____My fiancé appreciates my intelligence

_____My fiancé treats me as an equal

_____My fiancé encourages me to stretch my talents

_____My fiancé readily accepts my circle of friend

_____My fiancé encourages me to pursue and maintain friendships

_____My fiancé tends to be selfish of my time and attention

Page 7

Why are you getting married? (List five reasons in their order of importance to you)

1.

2.

3.

4.

5.

What do you expect of marriage? Finish this statement:

“I expect to get

1.

2.

3.

“I expect to give

1.

2.

3.

In what ways do you think you will be a better person married than you could be by remaining single?

List at least eight subjects you have discussed together (number of kids, financial status, and goals, etc.):

1.

2.

3.

4.

5.

6.

7.

8.

Have you had any disagreements?

How were they solved?

How do you express anger?

Page 8

What changes do you want to make in your partner?

Describe what you believe should be the husband’s role in marriage. Be as specific as possible.

Describe what you believe should be the wife’s role in marriage. Be as specific as possible.

Are you paying alimony, child support, or are you legally bound to provide any other form of support (financial or otherwise) to any dependents, ex-wives, or former significant others? If so, who?

Are you living with your fiancé?

If yes, explain:

Sexual Health and History

These confidential questions are not meant to be intrusive, but rather to ensure that each partner is aware of one another’s sexual health and history regardless of your past or current experience. The Pastor will require those seeking marriage to abstain from future sexual intimacy until the wedding, thus honoring the scriptures.

Have you and your fiancé been sexually involved with each other at all during the time you’ve known each other?

If yes, are you currently involved with one another, sexually?

Are you willing to abstain from sexual intimacy from now until your wedding date, thus honoring the scriptural call for chastity?

Do you have any children?

If so, list their names, birthdates, and biological fathers:

Have you been sexually involved with anyone other than your fiancé at any time in your past?

Have you ever been tested for a sexually transmitted disease? (AIDS, Gonorrhea, Syphilis, etc.)

If so, which diseases (if any) have you tested positive for?

Have you communicated your sexual history completely and honestly with your fiancé?

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