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Self-Advocacy Checklist

Total questions: 12

Worksheet time: 12mins

Name
Class
Date
1.

Do you tell teachers, staff, and your family what you like to do?

a)

5 - Always

b)

4 - Most of the time

c)

3 - Sometimes

d)

2 - Rarely

e)

1 - Never

2.

Do you make choices regarding supports, accommodations, and activities that you want or need?

a)

5 - Always

b)

4 - Most of the time

c)

3 - Sometimes

d)

2 - Rarely

e)

1 - Never

3.

Can you describe and talk about your disability?

a)

5 - Always

b)

4 - Most of the time

c)

3 - Sometimes

d)

2 - Rarely

e)

1 - Never

4.

Do you ask for help when you need it?

a)

5 - Always

b)

4 - Most of the time

c)

3 - Sometimes

d)

2 - Rarely

e)

1 - Never

5.

Can you identify what kind of help you need and ask for it in a way that others understand?

a)

5 - Always

b)

4 - Most of the time

c)

3 - Sometimes

d)

2 - Rarely

e)

1 - Never

6.

Can you describe your strengths and weaknesses?

a)

5 - Always

b)

4 - Most of the time

c)

3 - Sometimes

d)

2 - Rarely

e)

1 - Never

7.

Can you describe your rights under IDEA and ADA?

a)

5 - Always

b)

4 - Most of the time

c)

3 - Sometimes

d)

2 - Rarely

e)

1 - Never

8.

Do you have a support group including family, friends to help you accomplish your short and long term goals?

a)

5 - Always

b)

4 - Most of the time

c)

3 - Sometimes

d)

2 - Rarely

e)

1 - Never

9.

Do you work with your IEP teacher to develop your IEP and transition plan?

a)

5 - Always

b)

4 - Most of the time

c)

3 - Sometimes

d)

2 - Rarely

e)

1 - Never

10.

Can you keep track of how you’re doing in school and on your IEP goals?

a)

5 - Always

b)

4 - Most of the time

c)

3 - Sometimes

d)

2 - Rarely

e)

1 - Never

11.

Do you make plans to do leisure activities with others?

a)

5 - Always

b)

4 - Most of the time

c)

3 - Sometimes

d)

2 - Rarely

e)

1 - Never

12.

Tell 3 things that you feel that other could do better to help you build your self advocacy skills?

4 lines