Question: Mybehaviorchangewillbe ( process ) : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Mybehaviorchangewillbe (process):____________________________________________________________________________________________________________Mylong-termgoalforthisbehaviorchangeis (outcome):____________________________________________________________________________________________________________Thesearethreeobstaclestochange(thingsthatIamcurrentlydoingorsituationsthatcontributetothisbehaviorormakeithardertochange):1.2.3.ThestrategiesIwillusetoovercometheseobstaclesare:1.2.3.ResourcesIwillusetohelpmechangethisbehaviorinclude:afriend/partner/relative:___________________________________________________________________________________a school-basedresource:___________________________________________________________________________________acommunity-basedresource:___________________________________________________________________________________abookorreputablewebsite:___________________________________________________________________________________Inordertomakemygoalmoreattainable,Ihavedevisedtheseshort-termprocessgoals.short-termgoal: targetdate: reward:short-termgoal: targetdate: reward:short-termgoal: targetdate: reward:WhenImakethelong-termbehaviorchangedescribedabove,myrewardwillbe:Targetdate:Iintendtomakethebehaviorchangedescribedabove.Iwillusethestrategiesandrewardsto achievethegoalsthatwillcontributetoahealthybehaviorchange.Signed:______________________________________Witness:_________

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