Request edit access
Student Self Assessment
Sign in to Google to save your progress. Learn more
1. What grade are you enrolled in *
2. How old are you *
3. How do you identify *
4. English is my first language (1= True, 0= False) *
Engagement
5. I concentrate on my school work *
Never.
Always.
6. I complete my schoolwork regularly. *
Never.
Always.
7. I take responsibility for working towards my goals. *
Never
Always
8. I know I will graduate from high school. *
Never.
Always.
9. I plan for what I want to do after high school *
Never
Always
10. Setbacks don't discourage me. *
Never
Always
11. I finish whatever I begin *
Never
Always
Self-Awareness
12. I can identify my emotions, needs and values. *
I can never.
I can always.
13. I understand my reasons or triggers for doing/saying things. *
I can never.
I can always.
14. I recognize my strengths. *
I can never.
I can always.
15. I can be self-confident. *
I can never.
I can always.
16. I can make a difference by what I do. *
I can never.
I can always.
Self-Management
17. I can set goals, works toward them and monitor progress. *
I can never.
I can always.
18. I can seek help when needed. *
I can never.
I can always.
19. I can think before I act (control my impulses). *
I can never.
I can always.
20. I can display grit, determination, perseverance. *
I can never.
I can always.
21. I can manage my stress. *
I can never.
I can always.
22. I can control my behavior. *
I can never.
I can always.
23. I can motivate myself. *
I can never.
I can always.
24. I can show positive emotions: hope, optimism, motivation. *
I can never.
I can always.
25. I can organize my day. *
I can never.
I can always.
Social Awareness
26. I can recognize social cues from others. *
I can never.
I can always.
27. I listen closely and accurately. *
I can never.
I can always.
28. I look at things from others' points of view. *
I can never.
I can always.
29. I feel empathy for others. *
I can never.
I can always.
30. I appreciate diversity and differences among people. *
I can never.
I can always.
31. I respect others' feelings and reactions. *
I can never.
I can always.
Relationship Management
32. I can communicate my ideas and feelings effectively. *
I can never.
I can always.
33. I talk to many different people in school and make friends easily. *
I can never.
I can always.
34. I show leadership skills. *
I can never.
I can always.
35. I know how to build relationships and help others. *
I can never.
I can always.
36. I know how to work with a team, cooperatively. *
I can never.
I can always.
37. I work toward group goals. *
I can never.
I can always.
38. I try to prevent interpersonal conflict. *
I can never.
I can always.
39. I resist (do not follow) inappropriate social pressures. *
I can never.
I can always.
Responsible Decision-Making
40. I can identify problems. *
I can never.
I can always.
41. I analyze situations before I act. *
I can never.
I can always.
42. I use strategies to resist peer pressure. *
I can never.
I can always.
43. I evaluate many ideas and perspectives to solve problems. *
I can never.
I can always.
44. I reflect on my own actions and thinking. *
I can never.
I can always.
45. I am ethical and fair. *
I can never.
I can always.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Haverhill Public Schools. Report Abuse