Marriage Enrichment Application

Name

First Name

Last Name

Email

Preferred Method of Contact

select one

Email

Phone

How long have you been married?

Strengths and Weaknesses

Looking at your marriage currently, please describe 3 strengths and 3 areas needing growth.

Previous Counseling/Course Experience

Please describe any previous counseling or marriage related work you've done.

How did you hear about this course?

Hopes for Outcomes

What do you hope to see happen in your marriage as a result of having done this course?

***you can expect to hear from us within 2 business days

113 D North Broad Street
Grove City, PA 16127