I statements
100

You feel like your parents are always telling you what to do and don't hear you out.

(4 part I statement) I feel (1: feelings about the situation) frustrated when (2: blame free description of the behavior that is a problem for me) you do not hear what I'm saying because (3: the effect of the problem behavior on me) I feel misunderstood. I need (4: what you need the other person to do instead) you to listen and acknowledge what I am saying.

200

In third period you want to use a pass but the teacher is not letting you. 

4 part I statement: 

I feel (1: feeling about the behavior) upset when (2: blame free description of the behavior that is a problem for me) I am not allowed to use a pass because (3: the effect of the problem behavior on me) I am not able to go to the nurse. I need (4: what I need the other person to do instead) you to allow me to use a pass so that I can get my medical needs met.

300

Your friend didn't invite you to their birthday party. You feel really upset and hurt. 

4 part I statement

I felt (1: my feelings about the situation) really upset and hurt when (2: blame free description of the behavior that is a problem for me) I wasn't invited to your birthday party because (3: the effect of the problem behavior on me) it made me question the strength of our friendship and your feelings towards me. (4: what I need from the other person instead) I need you to tell me why I wasn't invited and how you feel about our friendship. 

400

A classmate has asked you to borrow a pen. Every time you lend her one, you don’t get it back, so this time you say no. She gets angry
and starts to yell at you.

I feel upset when I let borrow a pen and don't return it because I only have 2 pens. I need you to return pens I let you borrow.
500

You have to do a group project with other students. However, you don’t agree with the way your group is doing things.

I feel frustrated when the group doesn't let everyone contribute to discussions because we are a team. I need the group to let everyone have a say