Xavier [Student ID: Xavier]

Instance of: Assertiveness Performance-Based Observation
Administered By: schiffelbein, susan
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Grade: 5      Date Taken: 4/23/25

Question	Reversed?	Topic	VERY like me	5	4	3	2	1	NOT like me
1. Respectfully expresses basic feelings and preferences.		Assertiveness Observation

Quiz Section

Question	Correct Answer	Were You Correct?
1. Respectfully expresses basic feelings and preferences.		NO
2. Communicates a need or want to peers and adults in a respectful manner.		Assertiveness Observation
2. Communicates a need or want to peers and adults in a respectful manner.		NO
3. Demonstrates respectful refusal skills.		Assertiveness Observation
3. Demonstrates respectful refusal skills.		NO
4. Demonstrates nonverbal assertive communication (e.g., body language, tone of voice).		Assertiveness Observation
4. Demonstrates nonverbal assertive communication (e.g., body language, tone of voice).		NO
5. Demonstrates assertive communication during collaborative learning.		Assertiveness Observation
5. Demonstrates assertive communication during collaborative learning.		NO
6. Determines personal boundaries and generates assertive statements to apply if boundaries are compromised.		Assertiveness Observation
6. Determines personal boundaries and generates assertive statements to apply if boundaries are compromised.		NO
Multiple Choice Score:	0/6	0%