Student self-assessment checklist for evaluating self-advocacy skills.

This document is a Self-Advocacy Checklist. It is not a math problem with one single correct answer. Instead, it is a tool for you to think about your own skills and how much help you need.

Because every student is different, there is no "right" or "wrong" answer key. The correct way to fill this out is to be honest about your own feelings and abilities.

Here is a guide on how to complete each part of the form yourself:

Step 1: Fill in Your Info

At the very top, write your:
* Student Name
* Birthdate
* Grade

Step 2: Understand the Scoring (Left Side)

For questions 1 through 6, look at the scale provided in the directions:
* 5 = Always (You do this every single time.)
* 4 = Most of the time (You usually do this, but maybe not always.)
* 3 = Sometimes (You do it about half the time.)
* 2 = Rarely (You almost never do this.)
* 1 = Never (You do not do this at all.)

Read each question carefully and circle or write the number (1–5) that best describes you.

The Questions:
1. Do you tell teachers/staff what you family want you like to do? *(Note: The text in the image has some typos, but it likely means: "Do you tell teachers or staff what you or your family wants/likes?")*
* Think: Do you speak up about your preferences?
2. Do you make choices regarding supports/accommodations...?
* Think: When you get extra help (like sitting in the front or using a calculator), do you have a say in it?
3. Can you describe/disability? *(Likely means: "Can you describe your disability or learning needs?")*
* Think: Can you explain to someone why you learn differently?
4. Do you ask for help when you need it?
* Think: If you are stuck, do you raise your hand or ask a teacher?
5. Can you identify what kind of help you need...?
* Think: Do you know *what* specific thing would help you (e.g., "I need more time" or "I need the instructions written down")?
6. Can you describe your strengths and weaknesses?
* Think: Can you list things you are good at and things that are hard for you?

Step 3: Determine Level of Assistance (Right Side)

For each question, you also need to mark who helps you do these things. Choose only one line for each question:

* Independent: You do it all by yourself. No one helps you.
* Help from family/friends: Your parents, siblings, or friends remind you or help you do it.
* Help from teacher/employer: Your teacher or boss reminds you or helps you do it.

Example of how to fill out Question 4 ("Do you ask for help?"):
* If you always raise your hand by yourself without anyone telling you to, you might score it a 5 and check Independent.
* If you only ask for help when your mom tells you to, you might score it a 2 and check Help from family/friends.

Final Conclusion

To "solve" this homework assignment, you must print this sheet (or copy it onto paper) and fill in the blanks based on your own life. There is no external answer key because it is a personal self-assessment.