Name
*
First Name
Last Name
Date
Why did you show up to this workshop? (and/or) Why are you motivated to learn this model?
What are your fears about having conversations on culture and diversity?
Fear of: (check all that apply)
What other fears and anxieties get in your way?
What Topics and Contexts make you most anxious?
What other topics make you anxious?
Contexts: (check all that apply)
What other contexts make you anxious?
When I find myself in emotionally uncomfortable/intense situations related to topics on culture and diversity, I typically...(check all that apply)
I am aware of WHAT I am feeling
never
rarely
sometimes
often
always
I am aware of WHY I am emotionally dysregulated
never
rarely
sometimes
often
always
I can accept my emotions without judgment
never
rarely
sometimes
often
always
I am able to respond effectively without caving to my emotional impulses
never
rarely
sometimes
often
always
What are your Personal Core Values?
Check all the values that most resonate with you:
What other values, proverbs, mottos, or mantras are most important to you?
What other values, proverbs, mottos, or mantras are most important to you?
Check any openers that most resonate with you:
What other openers might you use in starting a constructive conversation?
Which of the following feedback have you ever received? (check all that apply)
What other negative feedback have you ever received about your non-verbal communication style?
Now go back and put a check next to those items that for you indicate cultural norms, expectations, or practices.
Which of the following feedback have you ever thought of/given to others? (check all that apply)
What other negative feedback about non-verbal communication styles have you ever thought of/given to others?
What can you do to minimize being misunderstood or to misunderstand others?
Rate your overall listening skills:
1- Nonexistent: Huh? Did you say something?
2- Poor: <50% accuracy of content, tone, affect, intention
3- Okay: 50-75% accuracy of content, tone, affect, intention
4- Good: 75-90% accuracy of content, tone, affect, intention
5- Excellent: 90-100% accuracy of content, tone, affect, intention
Which of the following have you ever engaged in while "listening" to someone giving you constructive/difficult feedback?
What can you do today to start developing better listening skills?
What else can you do to become a better listener?
Which of the following statements about apreciating the speaker most resonate with you?
What other ways might you appreciate the speaker for joining you in the constructive conversation?
Which of the following statements about acknowledging what was said most resonate with you?
To any of the below, add something extra, such as "Did I get that right?" or "Did I ear you correctly?" or "Please let me know if I am off base."
What other ways might you acknowledge what was said?
What other ways might you share your impact?
Which of the following statements about hope for the future most resonate with you??
What other ways might you share your hope for the future?
Check the step(s) that most resonate with you.
Which of these steps can you start using right away?
Check the step(s) that you find the most challenging.
For each of the step(s) you checked, go back and make a few notes: (1) Why is this step challenging for you? (2) What can you do to or want to do in order to better learn, practice, and build the skill?
Using the KCCM, what constructive conversation can you have tomorrow?
Using the KCCM, what constructive conversation can you have next week?
Using the KCCM, what constructive conversation can you have in a month?