Most of the time -1

Often -2
Sometimes -3
Rarely -4
Almost never - 5

1 . I find it difficult to take a compliment.

2. I prefer not to criticize others, even if I am sure they are wrong.

3. I find it hard to tell someone that I have romantic feelings for him or her.

4. Im not comfortable asking my boss for a raise, even if I think I deserve it.

5. I avoid dealing with difficult situations involving confrontation.

6. I tend to be the leader in a group of friends.

7. I feel people take advantage of me.

8. Talking to people in positions of authority makes me feel nervous, self-conscious, or

unsure of myself.

9. I behave in a self-confident manner.

10. I express my opinions, even if others in the group disagree with me.

11. Most of the time Often Sometimes Rarely Almost never 1 2 3 4 5

11. I feel awkward

paying someone a compliment.

12. I am able to speak openly about my feelings.

13. I feel threatened when dealing with someone who is very assertive.

14. If I am not satisfied with the service in a restaurant, I let the waiter know.

15. I feel free to politely voice my disagreement with someone in a position of authority.

16. Opinionated people make me feel uncomfortable.

17. I put the needs of others ahead of my own needs.

18. When an argument is over, I replay the situation in my head, thinking of all the things I
could have said,
regretting that I hadn't thought of them then, or wishing I had the guts to say them.

19. I fear making phone calls to institutions, government agencies or businesses,

because I might sound stupid if I don't understand the instructions.

20. If my neighbors made too much noise, I would let them know

21. I feel comfortable saying no to people.

22. When I go out with other people, Ill do what they suggest, even if I feel like doing
something else.
23. I am able to express my anger or frustration with a friend or partner if I think it's justified.

24. Instead of arguing, I tend to accept responsibility for other people's mistakes.

25. I tend to just go along with what everyone else wants, instead of stating my own desires.

26. If a friend woke me up late at night with an unimportant phone call, I would say that.

I was already sleeping and prefer not to be called that late

27. I tend to be speechless when I am left alone with a person I find attractive

28. When a friend borrows something from me and forgets to return it, I feel comfortable
reminding her or him
29. I will use intimidation to ensure that I get my way.

30. I have been known to lose my temper and swear at people.

31.

Most people around me seem to be more assertive than I am.

32.

I have nothing to lose by asking questions in front of other people.

33.

At lunch, if my co-worker suggested going out for Chinese and I wanted

Italian, Id probably end up giving in and wed go for Chinese.

34.

When Im driving and other people are in the vehicle, I insist on listening to
the music I like at least some of the time.

35.

I tend to yell at people when I don't get my way.