Name
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First Name
Last Name
Email
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Date
MM
DD
YYYY
Current Grade Level:
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Middle School
9th Grade
10th Grade
11th Grade
12th Grade
13th - Grade (Past 12th grade, but not graduated high school)
I'm not currently enrolled in school
College
Name of School
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For each statement below, choose the option that best represents your knowledge of leadership skills.
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(Strongly Disagree) - I don't know where to start - 1 (Disagree) - I have not started, but I know what I need to do next - 2 (Neutral) - I am in the process of - 3 (Agree) - I have completed this, but I am not satisfied with the results - 4 (Strongly Agree) - I have completed this, and I am confident with the results - 5)
A. There are different styles of leadership.
B. I think I know what it takes to be a leader.
C. I am confident in myself.
D. I have empathy for others.
E. I have incredible communication skills.
F. I am good at making decisions.
G. I am a problem solver.
H. I think ethics and values play a role in leadership.
I. A good leader is in control of their emotions.
J. A good leader motivates others.
Describe the level of personal accountability you would have if were in the following scenario: you don't understand the content in class because of the teacher's teaching style.
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How often have you been placed in charge? (Group projects, Teacher's aide, Manager at job)
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Frequently
Occasionally
Rarely
Never
Have you ever been team captain before? (Sports/Gym class)
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Frequently
Occasionally
Rarely
Never
Have you ever had a job?
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Yes
No
Rate your leadership readiness skills on a scale of 1-5 (5 being the best).
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(Strongly Disagree) - 1, (Disagree) - 2, (Neutral) - 3, (Agree) - 4, (Strongly Agree) - 5
A. Self Awareness- I am in tune with my own feelings, motives, and desires.
B. Self Confidence - I believe in myself and take responsibility for my own decisions..
C. Empathy - I understand the perspectives and emotions of others and use this understanding to guide my actions.
D. Decision Making - I can make difficult decisions quickly and effectively.
E. Adaptability - I can adapt to new circumstances and pivot my strategies as needed.
F. Problem Solving - My problem-solving skills are excellent, as evidenced by my ability to understand tricky situations, think up new and clever ideas, and make things work well so we can see good results.
G. Passion - When given a job, I become passionate and enthusiastic about it..
H. Inspiring - I am often able to motivate and inspire others..
I. Self Reflection- I am able to receive feedback and constructive criticism in order to reflect on my success and continue to grow as an individual.
J. Self Management - I am able to remain in control of my emotions even in stressful situations.
or try a prompt below!
