My long term goal for this behavior change is:
These are 3 obstacles to change (things that I am currently doing or situations that contribute to this behavior to make it harder to change):
- __________________________________________
- __________________________________________
- __________________________________________
The strategies I will use to overcome these obstacles are:
1.___________________________________________
2.___________________________________________
3.___________________________________________
Resources I will use to overcome these obstacles are:
friend/partner/relative_______________________________________
school based resource___________________________________________________
Community based resource____________________________________
Book or reputable website_____________________________________
In order to make my goal more attainable, I devised these short term goals.
Short term Goals target date reward
1.___________________________________________________
2.___________________________________________________
3________________________________________________________________
When I make the long-term behavior change described above, my reward will be:
_________________________________________________date__
I intend to make the behavior change described above. I will use the strategies and rewards to achieve th4e goals that will contribute to a healthy behavior change.
signed_______________________________________witness___________________