STRENGTHENING YOUR AUTHENIC SELF ALLY FEEDBACK FORM

Thank you for participating in my self-reflection process! Please answer the following
questions honestly and openly, as I will be utilizing your feedback for my personal
growth. Please complete and return this form to me by ________________. This will give
both of us a chance to reflect on the questions. Once I have reflected on your
responses, I would like to meet with you for a few minutes before Tuesday, April 29 to
discuss your feedback, as well as my own reflections. Again, thank you!
1. Check six adjectives from the list below that best describe who I am.
Able
Accepting
Adaptable
Bold
Brave
Calm
Caring
Cheerful

Dependable
Dignified
Energetic x
Extroverted
Friendly
Giving
Happy
Helpful

Intelligent
Introverted
Kind
Knowledgeable
Logical
Loving x
Mature
Modest

Patient
Powerful
Proud
Quiet
Reflective
Relaxed
Religious
Responsive

Clever
Complex
Confident x

Idealistic
Independent
Ingenious

Nervous
Observant x
Organized

Searching
Self-assertive
Self-conscious

Sensible
Sentimental
Shy
Silly x
Spontaneous
Sympathetic
Tense
Trustworthy
x
Warm
Wise
Witty

2. What skill sets do you see me using most (in the work place, in the classroom, in
team settings)?
Based on these adjectives, I see you being a leader of a committee or a great member
of a creative team because I feel like youd function well with people!
3. What skill sets do you consider my strengths? What could I improve on?
I feel like you are an honest person (most of the time) and work well with creative
people and therefore would strive in that atmosphere. You could probably work on being
prompt.
4. In what areas do you see me shine (feel confident, relaxed, flexible) the most? Please
describe what you see or experience when you observe me in these areas.
You are very assertive when you want to accomplish something. The best example
would be when you are shopping or at a restaurant: you know what you want and dont
accept anything sub par.
5. In what arenas do you see me hold back my skills and strengths? Please describe
what you see or experience when you observe me in these areas.
The most Ive seen you hold back in is when youre confronted with something youre
not entirely sure of, thats when you seem to lose confidence in your abilities to
contribute ideas.
J. Thompson (Trinity University)
Adapted from Campus Life & Leadership, University of California, Berkeley