Behavior Change Assignment

2. I will begin on March 21, 2014 and plan to reach my goal of losing 25bs by April 21, 2014.

3. In order to reach my final goal, I have devised the following schedule of mini-goals. For each step in my program, I will give myself the reward listed.

My overall reward for reaching my final goal will be __________

4. I have gathered and analyzed data on my target behavior and have identified the following strategies for changing my behavior:

5. I will use the following tools to monitor my progress toward reaching my final goal: (list any charts, graphs, or journals you plan to use)

I sign (type your name) this contract as an indication of my personal commitment to reach my goal.

I have recruited a helper who will witness my contract and (list any way in which your helper will participate in your program).
Witness Name _________________   Date ______

Describe in detail any special strategies you will use to help change your behavior (refer to Activity 7).

Create a plan below for any charts, graphs, or journals you will use to monitor your progress. The log format you developed in Activity 3 may be appropriate, or you may need to develop a more detailed or specific record-keeping system. You might also want to develop a graph to show your progress; posting such a graph in a prominent location can help keep your motivation strong and your program on track. Depending on your target behavior, you could graph the number of push-ups you can do, the number of servings of vegetables you eat each day, or your average daily stress level.