Assignment Advocate Worksheet
Executive Function & Self-Advocacy
Assignment Advocate
Part 1: Asking for Help & Clarification
Name:
Date:
The Clarification Toolkit: 3 Ways to Ask for Help
1. Polite Opening
"Excuse me, [Teacher], when you have a moment, could I ask a quick question?"
2. Repeat / Rephrase
"Could you please repeat what we should do after finishing step 2?"
3. Model / Check
"Could you show an example or check if my first problem is set up correctly?"
Scenario Practice: Write Your Clarification Scripts
Read each situation where initial instruction was unclear. Write the exact words you would say to request help politely and appropriately.
1 Math Class • Multi-Step Problem
Request: Clarify a Step
Your teacher models a 3-step algebra problem on the board and tells everyone to start page 42. You understood the first step, but you are not sure how they got the positive number in step 2.
What would you do (e.g., raise hand) and say to your teacher?
2 English Language Arts • Essay Directions
Request: Repeat Directions
Your teacher gave directions for writing the rough draft while the classroom speaker system made an announcement. You missed whether the thesis statement goes in paragraph 1 or at the end.
Write your exact question to ask the teacher to repeat the instruction:
3 Science Lab • Station Materials
Request: Confirm Expectations
The teacher says: "Read the safety sheet, grab your tray from the counter, and calibrate scale B before starting." You aren't sure which counter has scale B or how to calibrate it.
Write how you will politely ask for a demonstration or specific location:
Goal Standard: Ask appropriately in 4 out of 5 opportunities (80%) Page 1 of 3
Executive Function & Self-Advocacy
Assignment Advocate
Part 2: Planner Mastery & Assignment Tracking
Name:
Date:
The 4 Planner Essentials for Every Assignment
To reach your 80% weekly goal, every single assignment entry in your planner must clearly record:
1. Assignment Name
2. Due Date
3. Location (Classroom / Paper)
4. Status (Not Started / In Progress / Done)
Classroom Agenda Board: Read Today's 4 Announcements
Use the information below to record each task into your planner grid accurately.
Period 1: Math Whiteboard Note
"Handout: Slope-Intercept Practice. Complete problems #1-12 on your paper worksheet. Due tomorrow, Friday, Nov 7." (You have not begun yet.)
Period 3: Social Studies Google Classroom
"Digital Document: Constitution Landmark Cases Reflection. Posted on Google Classroom. Due Monday, Nov 10." (You have not begun yet.)
Period 4: Science Class Handout
"Cell Membrane Diagram Poster. Draw and label on large white construction paper. Due Wednesday, Nov 12." (You drew the outline during class; it is in progress.)
Period 6: English Google Classroom
"Theme Paragraph Draft. Submit typed document in Google Classroom by Tuesday, Nov 11 at 3:00 PM." (You wrote your first 2 sentences; it is in progress.)
Your Practice Planner Log
Assignment / Subject
Due Date
Location (Circle)
Status (Circle)
Classroom Paper
Not Started In Prog Done
Classroom Paper
Not Started In Prog Done
Classroom Paper
Not Started In Prog Done
Classroom Paper
Not Started In Prog Done
Reflection: Why is recording the location (Classroom vs. Paper) just as important as writing the due date?
Goal Standard: Independently record due date, location & status (80% across 5 school days) Page 2 of 3
Executive Function & Self-Advocacy
Assignment Advocate
Part 3: Integrated Simulation & Weekly Self-Review
Name:
Date:
Combined Mission: The Fast-Paced Class
During History, your teacher announces: "Your 1920s Culture Graphic Organizer is due next Thursday, Nov 13. Submit it online through Classroom, but make sure you attach the scanned primary source notes sheet from your binder!" The bell is about to ring in 3 minutes, and you are unsure how to attach a scanned page to Classroom.
A Action 1: Self-Advocacy Script
What specific question will you ask your teacher before leaving or during office hours?
B Action 2: Planner Entry
Record this task in your planner row completely with all required fields:
Assignment / Subject
Due Date
Location (Circle)
Status (Circle)
Classroom Paper
Not Started In Prog Done
My 5-Day School Week Self-Monitoring Audit
Use this weekly checklist with your case manager or teacher to verify your 80% (4 out of 5) target across all classes.
Target Skill
Monday
Tuesday
Wednesday
Thursday
Friday
Asked for help when stuck
Logged Due Date
Logged Location (Class/Paper)
Tracked Status (Done/In Prog)
Weekly Goal Met? Yes (4+/5) Working On It
Reviewer Signature:
Integrated Goal Review: Self-Advocacy & Planner Independence Page 3 of 3
