Self-Determination Checklist - Student Self-Assessment printable pdf download

Self-Determination Checklist - Student Self-Assessment

Self-Determination Checklist

Student Self-Assessment

Student Name:

Date:

Self-Determination skills help you to know

yourself

your goals

supports you need to reach your goals

Use the following scale to rate the statements below:

3 = almost always/most of the time

2 = sometimes

1 = rarely or never

Rating

3 2 1

I set goals to get what I want or need.

3 2 1

I make plans for reaching my goals.

3 2 1

I check my progress on how I am doing toward my goals.

3 2 1

I attend my IEP Meetings.

3 2 1

I participate in my IEP Meetings.

3 2 1

I know the goals listed in my IEP.

3 2 1

At school, educators listen to me when I talk about what I want or need.

3 2 1

At home, my parents listen to me when I talk about what I want or need.

3 2 1

I have others in my life who help me to accomplish my goals.

3 2 1

I ask for help when I need it.

3 2 1

I know what I need, what I like and what I enjoy doing.

3 2 1

I tell others what I need, what I like and what I enjoy doing.

3 2 1

I help to make choices about the supports (educational services) and

accommodations that I need in school.

3 2 1

I can describe my learning difficulties to others.

3 2 1

I believe I have control to direct my life.

3 2 1

I take care of my personal needs (clothes, chores, meals, grooming).

3 2 1

I make friends with others my age.

3 2 1

I make good choices.

3 2 1

I believe that working hard in school will help me to get a good job.

2008 Commonwealth of Virginia Department of Education

Training and Technical Assistance Centers - I’m Determined Project

Self-Determination Checklist ~ Student Self-Assessment

Self-Determination Checklist - Student Self-Assessment

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