Nonviolent Communication Inquiry Form
Please use this form to reflect on a recent interaction or situation using the principles of nonviolent communication. Your responses will help guide your understanding and growth. All fields are required for a complete inquiry.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Date of the Situation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Briefly describe the situation or interaction you are reflecting on.
*
What did you observe (without judgment or evaluation)?
*
What feelings did you experience in this situation?
*
What needs of yours were connected to these feelings?
*
What request would you like to make (to yourself or others) moving forward?
*
How do you intend to follow up or integrate this learning?
*
Is there anything else you’d like to share about your NVC inquiry?
Submit Inquiry
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