Assertiveness 4th Grade [Student ID: is1131]

Instance of: Assertiveness Questionnaire (7-12)
Administered By: Murphy, Blythe
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Grade: 4Gender: male 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.



QuestionReversed?TopicVERY
like me		54321NOT
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.'YESExpress 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.YESExpress Myself
6. I tend to just go along with what everyone else wants instead of stating my own thoughts.YESExpress Myself
7. I sometimes avoid asking questions for fear of sounding stupid.YESExpress Myself
8. I tend to bottle up my emotions rather than talk about my feelings.YESExpress 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.YESRespect 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