NAME Center Monthly Report

NAME Center*

Please enter the name of your church

CNDs*

First and Last names of the CND couple

Email Address*

Month

Premarital Appointment Information

Applies to non-married couples only

Did you have any premarital counseling sessions this month?*

Yes

No

How many premarital couples did you counsel this month?*

Total number of couples

Number of premarital counseling appointments*

Total number of appointments from all premarital couples

Did any premarital couples cancel their engagement?*

Yes

No

Number of premarital couples who canceled their engagement:*

Total number of appointments from all premarital couples

Were there any salvations or rededications to Christ during premarital sessions?*

Yes

No

Number of premarital salvations or rededications:*

First Time Counseling Appointments

Applies to married couples visiting NAME for the first time

Did you have any FIRST TIME marriage counseling sessions this month?*

Yes

No

How many first time couples did you counsel this month?*

Total number of new couples

Number of first time counseling appointments*

Total number of appointments from all first time couples

Were any first time couples separated before the first appointment?*

Yes

No

Number of first time couples separated*

Did any first time couples choose to separate this month?*

Yes

No

Number of first time couples who chose to separate*

Were there any salvations or rededications to Christ during sessions with the first time couples?*

Yes

No

Number of salvations or rededications for first time couples*

Did any first time couples reconcile during counseling apointments?*

Yes

No

Number of first time couples that reconciled*

Ongoing Couple Appointment Information

Applies to married couples who have been to NAME in the past and/or currently attending

Did you have any ongoing marriage counseling sessions this month?*

Yes

No

How many ongoing couples did you counsel this month?*

Total number of couples NOT including first time or premarital

Number of ongoing counseling appointments*

Total number of appointments not including new or premarital couples

Are any ongoing couples currently separated?*

Yes

No

Number of ongoing couples currently separated*

Did any ongoing couples make a decision to separate this month?*

Yes

No

Number of ongoing couples who chose to separate*

Were there any salvations or rededications to Christ during sessions with ongoing couples?*

Yes

No

Number of salvations or rededications:*

Not including new or premarital couples

Did any ongoing couples reconcile this month?*

Yes

No

Number of couples reconciled*

Not including new or premarital couples

Totals

Total number of couples counseled this month

Total number of counseling appointments this month

Total number of new salvations and rededications this month

Total number of reconciliations this month

Total number of couples currently separated this month