This form is an opportunity to check-in with yourself and Jim about moving towards certification and integration. Your answers are private, seen only by Jim Manske. If you would like  to connect about your responses, reactions, of have any other feedback, please write to

So far, the range of reports about how long this self-assessment form took vary from 20 minutes to 3 hours to "A long time".

Feel free to find a way to make this work for you, including writing your responses "off-line", then pasting your answers into the form. The form allows you to revisit it and update it, but as far as I can tell, you must revisit at least once every 30 days to keep that function.
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Email *
Name *
What feelings and needs are alive in you right now? *
Who is your assessor? (A copy of your responses will be emailed to the address you provided. Feel free to forward a copy of your report to your assessor/mentor/podmates, etc.) *
What pod/learning group/cerification program are you participating with? *
What is your vision statement? (For me, a vision statement refers to your dream of the world. How would you like the world and its systems to be?) *
How would you describe your gratitude practice? *
How would you describe your journaling practice? *
How many training log entries for the training you offered are in your portfolio? *
How many training log entries for the training you received are in your portfolio? *
There are 25 KDs in the CPP. How many have you completed? (Complete, for me, means written and includes: Definitions of key terms, description of the difference that makes a difference, a story that illustrates the distinction, and anything else you think is helpful. The final evidence of completion is that the KD is in your portfolio.) *
Which KDs are you most confident about integrating? *
Which KDs are you least confident about integrating? *
There are twelve basic NVC processes listed in the CPP.  Please check the boxes for the basic processes that you feel ready and confident to teach if invited to a workshop next weekend. Evidence of preparation might include: A handout; an outline or agenda; a practice that could support discovery and insight for the participant, a powerpoint presentation, etc. *
There are some key points about the NVC Model. Please check the boxes that you feel confident about explaining to someone you met in a coffee shop. *
There are some frequently asked questions in training listed in the CPP. Which are you most confident about answering? *
Who do you identify as your CNVC mentor(s)? *
How would you describe your mission in relation to CNVC's mission? (For me, mission refers to the specific part you would like to play in making your vision come to fruition. You can read CNVC's mission at *
If you were your mentor/assessor, what advice would you give to yourself? *
How would you describe your competence as a trainer? *
How would you describe your competence as a facilitator? *
How would you describe your competence as a mediator? *
What is the purpose of Nonviolent Communication? *
Before you "practice" Nonviolent Communication, how would you describe your intention? *
When you are practicing Nonviolent Communication, where do place your attention? *
How does your practice of Nonviolent Communication affect your life? *
If you could only use one or two words to describe your experience of Nonviolent Communication, what would they be? *
What makes Nonviolent Communication unique compared to other modalities (e.g. mindfulness, IFS, Process Work, Byron Katie, etc)? *
Please consider a self-assessment using the Matrix and report your experience here.
What's your next step in fulfilling your aim to complete certification? How can I help? *
How long did you work with this survey? *
Any feedback that you sense would be helpful to consider before updating this survey?
A copy of your responses will be emailed to the address you provided.
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