Name:
Perception Check Assignment
Directions: For this assignment, please fill out this worksheet and explain how you practiced a perception check using all three steps.  You will need to practice a perception check this semester with another individual.  If you can’t talk to them in person, you can do it over the phone.  Try to avoid doing it over text if possible since that can often lead to more miscommunication. Details on how I will grade the assignment are on the second page.  
1)    Please provide a brief description of the situation that you want to use a perception check for.  For example: “I plan on confronting my roommate about why they continue to play loud music at night even though I told them it wakes me up.” Type your description below:
2)    Define what a perception check is:
3) Perception Check: Here you will tell me what you said to the other individual during all three steps of the perception check. (Using quotes) 
Step 1:  Description of behavior: (Ex: “Hey Jessica, I noticed that you haven’t called me back in a week.”)
Step 2:  Two possible explanations for that behavior: (Ex: “Is it because you have been busy or did I say something that hurt your feelings?”)
Step 3:  Request a response: (Ex: “I just wanted to check-in to see if everything was ok.”) 
4) Reflection: How did it go? Were they receptive and respectful or did they get defensive? Tell me how satisfied you were with how the perception check went. 
Grading: 20 points possible 
Step 1: 3 points= Student provided a brief description of the situation for a perception check.  Student provided enough information that I could understand why they needed to do a perception check. 
Step 2: 2 points= Clear definition of a perception check was provided. 
Step 3: 10 points= Performed all three steps of the perception check accurately.   
Step 4: 5 points = Student explained briefly how the perception check went, how well it was perceived by the other person, and how satisfied the student is after doing the perception check.