Spring Registration AND Pre-Survey Name First Name Last Name Email Phone (###) ### #### Which of the following situations do you hope to use tools from this Connecting with Compassion workshop in? (Choose any/all that apply) One-on-one with clients or community members One-on-one with people in positions of structural power (e.g. judges, bosses, school principals, elected officials) Helping two+ people in conflict (e.g. colleagues, families, allies disagreeing on strategy) Supporting community/groups resolving conflict at the communal/political level Conflict in my own family Conflict in my own workplace If I realize I am going to be absent or late to a session, I will let one of the facilitators know before session starts and as soon as I know. If I log in to class 10+ minutes after it has started, I acknowledge that I can participate fully in the class EXCEPT during breakouts, when I will be asked to wait in the main meeting room, because I may have missed key instruction. I agree to this. I don't agree to this. I want more clarity/to understand this more. I anticipate that I will be generally willing to turn my video on, to contribute to connection and presence in the group. Yes No I have a question about this. If I miss 1+ session, I anticipate that I will be open to having a conversation with facilitator(s) about making up the missed material or possibly participating in a future/next workshop series instead, for continuity of learning and trust in the group. Yes, I agree to this. No, I don't agree to this. I have a question about this or want to understand more about this. What's your connection to Fifth Ward, if any? (e.g. Do you, or have you, or are you intending to, work with folks in Fifth Ward? Or do/did you live in Fifth Ward?) Anything you would like to tell or ask workshop facilitators? I pay careful attention when other people talk to me about their troubles. For the questions below, choose the response that best fits you, where 1 is almost never and 5 is almost always. 1 - Almost never 2 3 4 5 - Almost always I notice when people are upset, even if they don’t say anything 1 - Almost Never 2 3 4 5 - Almost Always When I’m sad, I feel like other people are probably happier than I am 1 - Almost Never 2 3 4 5 - Almost always When I fail at something, I feel alone in the failure 1 - Almost never 2 3 4 5 - Almost always I like to be there for others when they’re struggling 1 - Almost never 2 3 4 5 - Almost always I am good at noticing when people are upset, even if they don’t say anything 1 - Almost never 2 3 4 5 - Almost always In difficult situations, I can pause without immediately reacting 1 - Almost never 2 3 4 5 - Almost always I tell myself I shouldn’t be feeling the emotions that I feel 1 - Almost never 2 3 4 5 - Almost always I have trouble thinking of the right words to express how I feel things 1 - Almost never 2 3 4 5 - Almost always I can notice my feelings without reacting to them 1 - Almost never 2 3 4 5 - Almost always I make judgments about whether my own thoughts are good or bad 1 - Almost never 2 3 4 5 - Almost always My natural tendency is to describe my feelings in detail 1 - Almost never 2 3 4 5 - Almost always I could be experiencing some emotion and not be conscious of it until some time later For the remaining questions below, choose the option that best fits you, where 1 is "Almost never" and 6 is "Almost always." 1 - Almost never 2 3 4 5 6 - Almost always I tend not to notice feelings of physical tension or discomfort until they really grab my attention 1 - Almost never 2 3 4 5 6 - Almost always I find myself listening to someone with one ear and doing something else at the same time 1 - Almost never 2 3 4 5 6 - Almost always I find myself preoccupied with the future or the past 1 - Almost never 2 3 4 5 6 - Almost always I find myself doing things without paying attention 1 - Almost never 2 3 4 5 6 - Almost always Thank you! If you have any add’l questions please email lwolfthal@fwtransformation.org Spring Adult Mid-Survey Name First Name Last Name I pay careful attention when other people talk to me about their troubles. For the questions below, choose the response that best fits you, where 1 is almost never and 5 is almost always. 1 - Almost never 2 3 4 5 - Almost always I notice when people are upset, even if they don’t say anything 1 - Almost Never 2 3 4 5 - Almost Always When I’m sad, I feel like other people are probably happier than I am 1 - Almost Never 2 3 4 5 - Almost always When I fail at something, I feel alone in the failure 1 - Almost never 2 3 4 5 - Almost always I like to be there for others when they’re struggling 1 - Almost never 2 3 4 5 - Almost always I am good at noticing when people are upset, even if they don’t say anything 1 - Almost never 2 3 4 5 - Almost always In difficult situations, I can pause without immediately reacting 1 - Almost never 2 3 4 5 - Almost always I tell myself I shouldn’t be feeling the emotions that I feel 1 - Almost never 2 3 4 5 - Almost always I have trouble thinking of the right words to express how I feel things 1 - Almost never 2 3 4 5 - Almost always I can notice my feelings without reacting to them 1 - Almost never 2 3 4 5 - Almost always I make judgments about whether my own thoughts are good or bad 1 - Almost never 2 3 4 5 - Almost always My natural tendency is to describe my feelings in detail 1 - Almost never 2 3 4 5 - Almost always I could be experiencing some emotion and not be conscious of it until some time later For the remaining questions below, choose the option that best fits you, where 1 is "Almost never" and 6 is "Almost always." 1 - Almost never 2 3 4 5 6 - Almost always I tend not to notice feelings of physical tension or discomfort until they really grab my attention 1 - Almost never 2 3 4 5 6 - Almost always I find myself listening to someone with one ear and doing something else at the same time 1 - Almost never 2 3 4 5 6 - Almost always I find myself preoccupied with the future or the past 1 - Almost never 2 3 4 5 6 - Almost always I find myself doing things without paying attention 1 - Almost never 2 3 4 5 6 - Almost always Thank you! If you have any add’l questions please email lwolfthal@fwtransformation.org
