Fillable Self-Determination Checklist Student Self-Assessment

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Self-Determination Checklist Student Self-Assessment

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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
Ratin
g
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 en
j
oy doing.
3 2 1 I tell others what I need, what I like and what I en
j
oy 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
j
ob.
2008 Commonwealth of Virginia Department of Education
Training and Technical Assistance Centers - I’m Determined Project
Self-Determination Checklist ~ Student Self-Assessment
1
Self-Determination Checklist
Student Self-Assessment
1. What is one (1) goal that you have for yourself?
2. List three (3) things you can do to reach this goal.
3. How can people around you (teachers, family, friends, etc.) help you to build
your self-determination skills?
4. List three (3) of your rights under the Individuals with Disabilities Education
Act (IDEA) and the Americans with Disabilities Act (ADA).
2008 Commonwealth of Virginia Department of Education
Training and Technical Assistance Centers - I’m Determined Project
Self-Determination Checklist ~ Student Self-Assessment
2
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Completed 9 February 2021

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