3CT Application

Please complete the form below. This information is confidential and is sent directly to the MRT Coordinator. Once complete you will be contacted with the next steps.

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Birth Date

YYYY

Spouse Motivation

My Spouse is willing to fully participate in the MRT Process

My Spouse is NOT currently willing to fully participate in the MRT process.

Reasons for Applying

This is optional, but we'd love to hear what are the primary issues affecting your marriage.