Assertiveness 5th Grade [Student ID: kd4407]

Instance of: Assertiveness Questionnaire (7-12)
Administered By: Murphy, Blythe
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Grade: 5

Gender: female

Date Taken: 2/1/19

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This assessment measures two important components of assertiveness:
1. Express Myself: Do you express your own opinions, needs, and preferences?

2. Respect Others: Do you show respect to others, even if you disagree?

The graph highlights your strengths.

Question	Reversed?	Topic	VERY like me	5	4	3	2	1	NOT like me
1. I stand up to my friends if they are doing something I don't feel comfortable doing.		Express Myself
2. I speak up when someone is not respecting my personal boundaries like 'no cheating off my homework' or 'I don't let friends borrow money.'		Express Myself
3. I often have a hard time saying 'No.'	YES	Express Myself
4. I express my opinions, even if others disagree with me.		Express Myself
5. When an argument is over, I often wish I would have said what was really on my mind.	YES	Express Myself
6. I tend to just go along with what everyone else wants instead of stating my own thoughts.	YES	Express Myself
7. I sometimes avoid asking questions for fear of sounding stupid.	YES	Express Myself
8. I tend to bottle up my emotions rather than talk about my feelings.	YES	Express Myself
9. If I disagree with my teacher, I talk to him or her about it.		Express Myself
10. If a person has borrowed money (or a game, clothes, or something else of value) and is overdue in returning it, I talk to the person about it.		Express Myself
11. I'm usually able to tell people how I'm feeling.		Express Myself
12. If I don't like the way someone is being treated, I speak up about it.		Express Myself
13. I speak up about things I really care about.		Express Myself
14. I am careful to avoid hurting other people's feelings, even when I feel that I have been wronged.		Respect Others
15. I have a hard time controlling my emotions when I disagree with someone.	YES	Respect Others
16. I avoid attacking someone's intelligence when I disagree with their ideas.		Respect Others
17. I listen to other people's opinions, even if I disagree with them.		Respect Others
18. In disagreements, I make sure that I understand other points of view.		Respect Others
19. In discussions, I communicate that I am listening through body language (nodding my head, avoiding rolling my eyes).		Respect Others
20. Even in an argument, I don't interrupt the other person.		Respect Others