A Community Service of The Center for Relationship Enrichment

Commitment Form

NWA Healthy Marriages

Our NWA Healthy Marriages Staff is always available to respond to your questions.

Please don't hesitate to call:
Stew Grant
Marriage Champion Coordinator
(479) 524-7351
mc@nwamarriages.com

Marriage Champions Commitment Form

The purpose of this information is to first provide NWA Healthy Marriages with a way to contact and communicate with you in the future. The second purpose is to provide NWA Healthy Marriages with a statement of your commitment as a Marriage Champion and your plan for the couples that you hope to work with. Thank you for your investment in the lives of couples in our area, and we greatly look forward to working with you as you directly impact the marriages and future generations of Northwest Arkansas!

Contact Information

Name of Marriage Champions: A value is required. Years Married: Preferred Email: A value is required.Invalid format. Phone: A value is required. Home/Business Address: Business/Organization/Church affiliation:

Commitment

Must have been married at least 5 years, take the Couple Checkup, and have a vitalized, harmonious or traditional couple type on the Couple Checkup.
Provide free marriage enrichment for 2 groups of 4 to 6 married or engaged couples and/or work individually with 4 to 6 married or engaged couples with a minimum of eight 8 hours enrichment education per group or individual couple on a yearly basis.
Begin your first group/individual meeting within 60 days of training while information is still fresh.
Provide marriage enrichment to all eligible persons, regardless of their race, gender, age, disability or religion.
Clearly inform each person that their participation is voluntary.
Participate in assessment and monitoring activities that measure program outcomes.
Will not proselytize or promote religion.
Pursue converting your marriage license into an Arkansas covenant marriage license.
Promote and explain how couples can obtain an Arkansas covenant marriage license.
Refer a domestic violence victim to the appropriate service for support.

Our Plan to Impact Couples

We plan to start our first group/individual meeting with our first couple(s) by: Invalid format. The location we plan to conduct our first group/individual meeting is: How might you recruit couples? What contacts do you have in your community that might help you with recruitment? We would like NWA Healthy Marriages to set up a voucher number and small group event date for couples to register online based on our planned start date: Yes / Not Yet

The couples we anticipate working with and where we will work with them includes (check all that apply):
Married	Engaged	Individual
Group	Community	Church
Business	Organization/Neighborhood	Other

Electronic Signature

We commit as a couple to the above plan as well as to the commitment of the Marriage Champion as listed above. By checking this box, we commit to the statement above. Please make a selection.
Image verification

To submit this form, please enter the characters you see in the image: A value is required. If you cannot read the image, click for a new one

Copyright © 2010 The Center for Relationship Enrichment
2000 West University Street
Siloam Springs, Arkansas 72761
479-524-7444 | info@nwamarriages.com | privacy policy

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Funding for this project was provided by the United States Department of Health and Human Services, Administration for Children and Families. Grant No. 90FE0004. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the United States Department of Health and Human Services, Administration for Children and Families.