Gottman Method Marathon Couples Therapy Application

Partner 1: What is your name (first and last)?*

Example: John Gottman
Partner 1: How old are you? (Age)*
Partner 1 Contact Email*
Partner 1 Phone Number*
Partner 2: What is your name (first and last)?*

Example: John Gottman
Partner 2: How old are you? (Age)*
Partner 2 Contact Email*
Partner 2 Phone Number*
What is the current status of your relationship today?*
- Married and living together
- Married, but not living together
- In a relationship and living together
- In a relationship, but not living together
- Separated
- Divorced
How long have you and your partner been in a relationship? (Please specify months and/or years)

Note: This the total time together
[Please note: if you are no longer in a relationship, please indicate the total length of time.]
How long have you been married?

If this doesn't apply, please skip
Do you have any children?*
- We do not have any children
- We have one or more children together
- We have children together and one of us has children from a prior relationship
- We have children together and both of us have children from a prior relationship
- One of us has children from a prior relationship and we don't have children together
- Both of us have children from prior relationships and we don't have children together
[Partner 1] What gender do you identify as?*
- Male
- Female
- Non-binary
- Transgender
[Partner 1] What is your ethnic or racial group membership?*
- Black or African-American
- Asian
- Latinx or Hispanic
- Non-Hispanic White or Euro-American
- Native American
- Native Hawaiian or Pacific Islander
If you are mixed-race, please select all that apply
[Partner 1] What is your identified sexual orientation?*
- Heterosexual
- Lesbian
- Gay
- Bisexual
- Queer
- Polysexual
- Pansexual
- Asexual
[Partner 1] What is your highest level of completed education?*
- Finished High School
- Received a GED
- Tradeschool
- Associate Degree
- Bachelor's Degree
- Master's Degree
- Doctorate Degree
- None
[Partner 1] What is your religious affiliation?
- Agnostic
- Atheist/Not Religious
- Buddhist
- Christian
- Hindu
- Jewish
- Muslim
- Spiritual
- Mormon
- Bahá’í
[Partner 2] What gender do you identify as?*
- Male
- Female
- Non-binary
- Transgender
[Partner 2] What is your ethnic or racial group membership?*
- Black or African-American
- Asian
- Latinx or Hispanic
- Non-Hispanic White or Euro-American
- Native American
- Native Hawaiian or Pacific Islander
If you are mixed-race, please select all that apply
[Partner 2] What is your identified sexual orientation?*
- Heterosexual
- Lesbian
- Gay
- Bisexual
- Queer
- Polysexual
- Pansexual
- Asexual
Please share
[Partner 2] What is your highest level of completed education?*
- Finished High School
- Received a GED
- Tradeschool
- Associate Degree
- Bachelor's Degree
- Master's Degree
- Doctorate Degree
- None
[Partner 2] What is your religious affiliation?
- Agnostic
- Atheist/Not Religious
- Buddhist
- Christian
- Hindu
- Jewish
- Muslim
- Spiritual
- Mormon
- Bahá’í
Who completed this application:*
- Partner 1
- Partner 2
- We did it together
Partner's Consent*
- I have my partner's consent to add their email to this form and they agreed to participate in this study.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is there any other important information that you would like to convey to the research team at this time?

Gottman Method Marathon Couples Therapy Application

Gottman Institute Marathon Research Study Application