Personal Impact Reflection Worksheet
Unit 2 • Self-Reflection & Community
How I Have an Impact on Those Around Me
Name:
Date:
Purpose & Privacy: The purpose of this prompt is to think about your own experiences and how you impact those around you. Share your honest thoughts to the best of your ability. This will not be shared with any of your peers unless you desire for it to be shared.
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Part 1: The Influence of Others on Your Life
Incoming Impact
First, write the name of a person who has impacted your life greatly:
How has this person impacted your life?
Would you say that having them in your life has helped to make you a better person?
Circle: YES NO
Why do you think so?
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Part 2: Your Impact on Someone Else
Personal Impact
Now give me the name of the person that you feel like you impact the most (aside from yourself):
How do you feel like you have impacted this person?
Would you say that this person’s life is better because they have you as a part of it?
Circle: YES NO
Why do you think so?
Unit 2 Reflection Activity Page 1 of 2 • Turn to Page 2
Unit 2 Reflection How I Have an Impact on Those Around Me
Student Name:
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Part 3: Making the World a Better Place
World Impact
If there was one thing that you could do, as you are now, that could help to make the world a better place by impacting others, what would you like to do?
Why do you think that this would be a good thing for others?
Creative & Extended Space
**You may use the rest of this space to continue writing, or draw.
[ Extended writing space or visual sketch of your positive impact ]
Draw or write here
Scoring Rubric
Teacher Score: / 10
0 — Doesn’t Meet
Student either does not attempt the prompt, or completes one or fewer of the portions of the prompt.
5 — Basic
Student either only writes minimal answers for each of the components, or only completes two of the portions of the prompt.
10 — Meets
Student writes down their thoughts with detail, and completes all three portions of the prompt.
End of Reflection Activity Page 2 of 2
