My reflection at a glance
HUMAN is what people need. LENS is how we create it.
Name
First Name
Last Name
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
My lowest-rated areas
Calculated after all nine ratings are completed. Includes ties at the third-lowest rating. A reflection starting point, not a diagnosis or a ranking of your worth.
Your self-ratings are a starting point for reflection, not a ranking of your worth or ability.
H · HEARD
I can speak honestly, ask questions, share ideas and raise concerns without fear.
Heard - my rating (1-10)
*
Choose a whole number: 1 = not true for me today; 10 = very true for me today. All nine ratings are needed to identify your lowest-rated areas.
Heard - current experience (brief highlight)
Up to 50 characters for the summary. Add more detail in the optional notes at the end.
Heard - what feels missing (brief highlight)
Up to 50 characters for the summary. Add more detail in the optional notes at the end.
U · UNDERSTOOD
People seek to understand my perspective, experience and context before making assumptions.
Understood - my rating (1-10)
*
Choose a whole number: 1 = not true for me today; 10 = very true for me today. All nine ratings are needed to identify your lowest-rated areas.
Understood - current experience (brief highlight)
Up to 50 characters for the summary. Add more detail in the optional notes at the end.
Understood - what feels missing (brief highlight)
Up to 50 characters for the summary. Add more detail in the optional notes at the end.
M · MEANING
I understand what I value and believe, can express it clearly, and connect my work to what matters to me.
Meaning - my rating (1-10)
*
Choose a whole number: 1 = not true for me today; 10 = very true for me today. All nine ratings are needed to identify your lowest-rated areas.
Meaning - current experience (brief highlight)
Up to 50 characters for the summary. Add more detail in the optional notes at the end.
Meaning - what feels missing (brief highlight)
Up to 50 characters for the summary. Add more detail in the optional notes at the end.
A · ACCEPTED
I can be myself without having to hide, mask, perform or become someone else to belong.
Accepted - my rating (1-10)
*
Choose a whole number: 1 = not true for me today; 10 = very true for me today. All nine ratings are needed to identify your lowest-rated areas.
Accepted - current experience (brief highlight)
Up to 50 characters for the summary. Add more detail in the optional notes at the end.
Accepted - what feels missing (brief highlight)
Up to 50 characters for the summary. Add more detail in the optional notes at the end.
N · NEEDS
I understand what I need to feel safe and supported, can meet those needs for myself, and communicate them clearly to others.
Needs - my rating (1-10)
*
Choose a whole number: 1 = not true for me today; 10 = very true for me today. All nine ratings are needed to identify your lowest-rated areas.
Needs - current experience (brief highlight)
Up to 50 characters for the summary. Add more detail in the optional notes at the end.
Needs - what feels missing (brief highlight)
Up to 50 characters for the summary. Add more detail in the optional notes at the end.
L · LISTEN
Create space for voice, dissent and honest feedback; protect each person's right to describe their own experience.
Listen - my rating (1-10)
*
Choose a whole number: 1 = not true for me today; 10 = very true for me today. All nine ratings are needed to identify your lowest-rated areas.
Listen - what I already do (brief highlight)
Up to 50 characters for the summary. Add more detail in the optional notes at the end.
Listen - what I could strengthen (brief highlight)
Up to 50 characters for the summary. Add more detail in the optional notes at the end.
E · EMPATHISE
Understand perspective, values, context and needs without requiring agreement; bring compassion alongside accountability.
Empathise - my rating (1-10)
*
Choose a whole number: 1 = not true for me today; 10 = very true for me today. All nine ratings are needed to identify your lowest-rated areas.
Empathise - what I already do (brief highlight)
Up to 50 characters for the summary. Add more detail in the optional notes at the end.
Empathise - what I could strengthen (brief highlight)
Up to 50 characters for the summary. Add more detail in the optional notes at the end.
N · NOTICE
Notice the person, the environment and yourself — including judgement, assumptions, power, silence, stress and exclusion.
Notice - my rating (1-10)
*
Choose a whole number: 1 = not true for me today; 10 = very true for me today. All nine ratings are needed to identify your lowest-rated areas.
Notice - what I already do (brief highlight)
Up to 50 characters for the summary. Add more detail in the optional notes at the end.
Notice - what I could strengthen (brief highlight)
Up to 50 characters for the summary. Add more detail in the optional notes at the end.
S · SUPPORT
Provide clarity, feedback, autonomy, resources, development, boundaries and follow-through; respond rather than rescue.
Support - my rating (1-10)
*
Choose a whole number: 1 = not true for me today; 10 = very true for me today. All nine ratings are needed to identify your lowest-rated areas.
Lowest-rating cutoff
Lowest area - Heard
Lowest area - Understood
Lowest area - Meaning
Lowest area - Accepted
Lowest area - Needs
Lowest area - Listen
Lowest area - Empathise
Lowest area - Notice
Lowest area - Support
Support - what I already do (brief highlight)
Up to 50 characters for the summary. Add more detail in the optional notes at the end.
Support - what I could strengthen (brief highlight)
Up to 50 characters for the summary. Add more detail in the optional notes at the end.
My reflection focus
Your own reflections, not a diagnosis or validated score. No total or inferred gap is calculated.
Brief highlights only. Keep full responses in your complete reflection guide.
HUMAN LENS® | Authentic Ewe®
Personal reflection summary
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Optional notes - anything else you would like to record
Use this space for longer reflections. These notes are kept with your submission and email copy, not squeezed into the one-page summary. Please avoid names or private details about other people.
Your privacy and consent
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I agree to my answers being stored in Jotform and shared with Penelope at Authentic Ewe to provide my reflection summary by email. Written reflections are optional; all nine ratings are needed for the comparison. This is not a diagnostic assessment or a marketing subscription.
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