Name
*
First Name
Last Name
Email Address
*
Phone
(###)
###
####
Marriage is sacred to the Lord, and because of that, we believe that a couple should not live together before they are married. Are you willing to comply make this commitment?
God has designed sex for the context of marriage, because of that, we believe that a couple may not engage in any form of pre-marital sex until they are married. Are you willing to remain sexually pure until you're married?
1. Name of future spouse
2. Length of acquantance
3. If engaged, for how long a period
4. Wedding Date
5. Number of previous engagements
6. Number of previous marriages
7. Number of children in your parent's family, including yourself
8. Check the type of community in which you spent most of your childhood and youth:
9. Check the highest level of schooling completed now or which you plan to complete soon:
10. Check what you consider to be the social status of your parents in their community:
11. As a child, did you have:
12. As a child, did you feel:
13. Your appraisal of adequacy of your sex education received as a child from sources other than your parents:
14. Your appraisal of adequacy of your sex education received as a child from your parents:
15. Your appraisal of the family atmosphere while you were a child:
16. Your adjustment to grade school was:
17. Your attitude toward your father when you were still a child:
18. Your attitude toward your mother when you were still a child:
19. Your appraisal of the severity of your discipline while a child:
20. Check what you consider to be the marital adjustment of your parents during most of your childhood and adolescence:
21. Your appraisal of the adequacy of your knowledge of puberty and sex when you entered adolescence:
22. Your appraisal of your degree of independence from your parents during adolescence:
23. Your appraisal of your dating habits during high school:
24. Your wish for your children's future dating behavior as compared to your experience:
25. Check what you consider to be the extent of the dominance your father exerted over the other members of your family:
26. Check what you consider to be the extent of the dominance your mother exerted over the other members of your family:
27. Approximately how many times have you discussed your future financial plans and problems?
28. What has been the result of these discussions:
29. Have you discussed a budget:
30. Have you discussed savings:
31. How much debt are you bringing into this marriage?
32. Have you discussed both spouses working:
33. Have you discussed buying a home:
34. Have you discussed who will manage the money:
35. Have you discussed your occupational plans:
36. Have you discussed household furnishings:
37. Which of these topics caused conflicts?
1) Budgeting
2) Savings
3) Spouses Working
4) Buying a home
5) Who will manage the money
6) Occupational Plans
7) Household furnishings
38. Which of these would you like to discuss and why?
1) Budgeting
2) Savings
3) Spouses Working
4) Buying a home
5) Who will manage the money
6) Occupational Plans
7) Household furnishings
39. Approximately how many times have you discussed your future activities and problems?
40. What is the result of these discussions:
41. List the recreational ACTIVITIES OF YOUR FUTURE MATE that you do NOT participate in:
42. List the recreational activities that are important to YOU that your future mate does NOT participate in:
43. List the different recreational activites in which you and YOUR FUTURE MATE have participated as a couple more than once in the last six months:
44. In what church did you receive your childhood religious training?
45. How intensive was it?
46. At present, how long have you been attending New Life?
47. Approximately how many times have you discussed what you believe with your future mate?
48. What has been the result of these discussions:
49. Have you discussed how your belief in God will influence how you will raise your children?
50. Have you discussed church attendance?
51. Have you discussed birth control?
52. Have you discussed how your beliefs will shape your marriage?
53. Which of these areas caused conflict?
1) How your belief in God will influence how you will raise your children
2) Church attendance
3) Birth control
4) How your belief in God will shape your marriage
54. Which of these topics would you like to discuss and why?
1) How your belief in God will influence how you will raise your children
2) Church attendance
3) Birth control
4) How your belief in God will shape your marriage
55. How often have you worshipped together in the last 6 months?
56. Rate your religious interest by answering the survey questions below:
Please indicate the degree to which you agree with the following statements.
My faith in God is central to who I am and every decision I make:
My FUTURE MATE'S faith in God is central to who they are and every decision they make:
57. Approximately how many times have you discussed children and how they will be raised?
58. What has been the result of these discussions:
59. Have you discussed methods of discipline:
60. Have you discussed number of children:
61. Have you discussed sex education:
62. Have you discussed when you want children:
63. Which of these caused conflict?
1) Methods of discipline
2) Number of Children
3) Sex education
4) When you want children
64. Which of these topics would you like to discuss and why?
1) Methods of discipline
2) Number of Children
3) Sex education
4) When you want children
65. Approximately how many times have you seriously discussed the degree of sexual intimacy you should permit while going steady or being engaged?
66. What has been the result of these discussions?
67. Have you discussed birth control?
68. Have you discussed achieving good sexual relations in marriage?
69. Have you discussed how you show affection towards one another?
70. How free have you been as a couple in demonstrating affection?
71. How free have you been as individuals in putting your affectionate feelings into words?
72. Which of these caused conflict?
73. Which of these would you like to discuss?
74. Approximately how many times have you seriously discussed your relations now and in the future with your in-laws?
75. What has been the result of these discussions?
76. Have you discussed the proximity of your home to your in-laws?
77. Have you discussed your dependence on your parents?
78. Have you discussed the degree in which your in-laws may interfere in your marriage?
79. Have you discussed how to achieve happy relation with your in-laws?
80. Which of these caused conflict?
81. Which of these would you like to discuss?
82. Approximately how many times have you discussed the degree to which you understand each other's emotional needs and meet them?
83. What has been the result of these discussions?
84. Have you felt any need to be better understood?
85. Have you felt any need for warmth and closeness?
86. Have you felt any need for more tenderness?
87. Have you felt any blocks in expressing your own feelings?
88. Have you felt any hostility over dating conflicts?
89. Which of these caused conflict or withdrawal?
90. Which one of these would you like to discuss?
91. When you discuss a problem with your future mate, can you talk:
92. As you think about the conflict noted previously, how would you characterize your method of settling disputes?
93. In these disputes, what is the result?
94. In these disputes, can you:
95. Indicate your degree of agreement on the following items:
Drinking
Drugs
Gambling
Goals in life
Friends
Politics
Money
Amount of time spent together
96. Please list the things which have troubled you regarding your coming marriage:
97. Please list the irritations or annoyances which occur when you and your intended mate are together:
98. If you could make your mate "to order", what things would you change about him/her?
99. If you could relive your courtship with your intended mate, what things would you not do or do differently from what actually occurred?
100. Have you ever fallen into or been a part in any way of the following sins? (Sexual)
101. Do you have any of the following present in your life? (Addictions/Destructive Habits)
102. Describe your relationship with your father.
103. Describe your relationship with your mother.
104. Describe your relationship with your children.
105. Describe your relationship with your fiance.
106. Describe your social life.
107. What is the one thing you hoped WOULD NOT be asked in this questionnaire?
108. What is the one thing you hoped WOULD be asked in this questionnaire?
