Self-Reflection Worksheet

Name: _________________________ Date: _________________________

1. Describe a recent situation where you needed to speak up for yourself. Include who was involved, what you wanted, what you said, and the outcome.
   
   
   
   
   
   
   
   
   
   
   
   

2. Which strategy from the Self-Advocacy Strategy Poster did you use (for example, using “I” statements, staying respectful, speaking clearly)? How did that strategy help or not help in this situation?
   
   
   
   
   
   
   

3. Reflect on your feelings before, during, and after you spoke up. What emotions did you experience?
   
   
   
   
   
   
   

4. Think of a time when you hesitated to advocate for yourself. What stopped you from speaking up? If you could revisit that moment, how would you handle it differently?
   
   
   
   
   
   
   

5. Set a personal self-advocacy goal for the next week. Be specific: What situation will you practice in, which strategy will you use, and how will you know you succeeded?
   
   
   
   
   
   
   

Keep this worksheet and review your reflections after a week to track your progress!

Scenario Card Set

Use these scenario cards during the role-playing activity. Students draw one card, read the scenario aloud, and practice advocating for themselves using a chosen strategy from the Self-Advocacy Strategy Poster.

Cards:

1. Clarify Homework Instructions
   "You didn’t understand part of a homework assignment and need extra explanation. Ask your teacher politely to clarify what you need to do."
   
   
   
   

2. Group Project Fairness
   "In a group project, one teammate isn’t contributing their share. Tell them you need their help to finish on time and suggest how to divide tasks."
   
   
   
   

3. Cafeteria Mix-Up
   "You received the wrong lunch in the cafeteria. Approach the staff member and ask if you can get the meal you ordered."
   
   
   
   

4. Extra Time on Assignment
   "You have a reading difficulty and need more time to complete an in-class worksheet. Ask your teacher for an extension or support."
   
   
   
   

5. Interrupting Friend
   "A friend keeps interrupting you during conversations. Tell them how it makes you feel and ask if they can let you finish your thoughts."
   
   
   
   

6. Seat Change Request
   "You feel uncomfortable sitting next to a classmate. Ask your teacher if you can switch seats for better focus."
   
   
   
   

7. Presentation Jitters
   "You’re nervous about presenting first in front of the class. Ask your teacher if you can go later to give you time to prepare."
   
   
   
   

8. Noisy Study Hall
   "The study hall is too loud for you to concentrate. Ask the supervisor if there’s a quieter spot or if you can use headphones."

Role-Play Feedback Form

Your Name: _________________________ Partner’s Name: _________________________

Scenario Practiced: ____________________________________________

Strategy Used (from the Self-Advocacy Strategy Poster): ____________________________________________

1. What did your partner do well? Describe specific actions or phrases that were effective.
   
   
   
   
   
   

2. How clearly did they express their need or preference? Circle one and explain your choice.
   1 2 3 4 5 (1 = Not clear, 5 = Very clear)
   Explain:
   
   
   
   
   
   

3. Did they use an “I” statement? How did it affect the conversation?
   
   
   
   
   
   

4. Was their tone respectful and calm? Provide an example of what you heard or saw.
   
   
   
   
   
   

5. Suggestions for Improvement: What one thing could they work on to become a more confident self-advocate?
   
   
   
   
   
   
   

6. Next Strategy to Try: Which strategy from the poster would you recommend they practice next time? Why?
   
   
   
   
   
   

Thank you for your thoughtful feedback!

Self-Advocacy Strategy Poster

Empower yourself by using these simple strategies whenever you need to speak up. Your voice matters!

🗣️ Use “I” Statements

• Start with “I feel…,” “I need…,” or “I would like…”
• Focus on your own thoughts and feelings rather than blaming others
• Example: “I’m confused about the homework instructions. Could you please explain?”
  
  

🤝 Stay Respectful and Calm

• Keep your tone polite and even
• Show that you value the other person’s perspective
• Take a deep breath if you start to feel frustrated
• Example: “I understand you’re busy, but I need a little more time on this assignment.”
  
  

🔊 Speak Clearly and at a Good Volume

• Articulate your words and speak at a level everyone can hear
• Pause between key points to let your message sink in
• Maintain eye contact if comfortable
• Example: “Could we meet after class to go over the instructions?”
  
  

❓ Listen and Ask Questions

• Pay attention to the other person’s response
• Clarify anything you don’t understand by asking follow-up questions
• Show you’re open to feedback and willing to work together
• Example: “What do you think would help me complete this on time?”
  
  

Remember: Practicing these strategies in everyday situations—class discussions, group work, cafeteria lines—will help build your confidence and make your voice heard.

Your needs are important. Speak up, stand out!