Complete this sheet before responding to one request, or use it afterward to understand an agreement you regret. The useful result is an answer that represents capacity and choice. It is not a test of whether you are good, selfish or strong.

Copyable request-and-choice form

REQUEST, CAPACITY, CHOICE
Who asked / what was requested: ____________________________
When the answer or work is needed: _________________________
What I already committed to: _______________________________
What I have capacity to provide: ___________________________
What I want or prefer: ____________________________________
What I fear will happen if I answer honestly: ______________
Evidence / uncertainty about that consequence: _____________
Safety or power concern / support needed: __________________
My choice: YES / LIMITED OFFER / NO / NEED MORE INFORMATION
Exact response I will give: _______________________________
What I will do if the scope changes: ______________________
AFTERWARD: response received / actual commitment / next step
__________________________________________________________

Define the fields precisely

Capacity means available time, resources and ability for this request. Preference means what you would choose, separately from what you assume the other person wants. Safety or power concern stops the sheet from treating every refusal as equally safe. Limited offer states the part you can actually supply.

Kerub's chapter on people-pleasing challenges an approval bargain that erases the reader's own decisions. This sheet is a new editorial application of that lens, not a copied book exercise. [A_EGO:6]

Completed fictional example

Request: friend asks me to organize the entire reunion
Due: answer by Saturday
Existing commitment: work deadline this week
Capacity: one 30-minute call and checking two venue options
Preference: help with venues, not coordinate the event
Fear: friend may be disappointed
Evidence: disappointment is possible; no threat has been made
Safety concern: none identified in this example
Choice: limited offer
Response: I can compare two venues and join one planning call.
I cannot coordinate the whole event.
If scope grows: restate the offer; ask who owns coordination
Afterward: friend accepts the venue help; another person leads

The example's pleasant outcome is fictional. The form does not guarantee agreement or prevent another person's disappointment.

Rehearse without attacking

Read the response aloud. Remove unnecessary accusations about the other person's motives. Keep the requested work, contribution and limit clear. A truthful answer can be brief without being hostile.

CCI's assertiveness materials address communication styles and saying no. E03 They provide clinical context, but this original form is not their worksheet or a clinical instrument. If a request involves coercion or real danger, obtain suitable support rather than rehearsing a confrontation alone.

Review facts rather than imagined punishment

Afterward, record what was actually said and what you actually committed to. If the agreement changed, update it. If you agreed again despite limited capacity, examine that episode without turning it into a global verdict on yourself.