Change Tracker And
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Change Plan
Student Name:
Instructions: Use this template to document your results from the How Do I Plan to Change? section of the Change Planner. Delete the
Page 1 of 7 Copyright©2011 Cengage Learning. All Rights Reserved. Change Plan
Wellness Area: Physical Fitness
WHAT'S YOUR READINESS STAGE IN THE AREA OF PHYSICAL FITNESS?
MY SELF-REFLECTION REVELATIONS: SUMMARIZED
MY BEHAVIORAL CHANGE CONTRACT
1. I, _____, have decided to engage in a Physical Fitness Behavior Change.
2. My Goal:
3. The Objective(s) for my indicated Goal is/are:
4. I believe the following Enabling Factors will help me accomplish my Goal:
5. I believe the following Reinforcing Factors will help me accomplish my Goal:
6. I believe the following Obstacles might prevent me from achieving my Goal:
7. If I accomplish my Goal, I will reward myself with:
8. Timeline:
Page 2 of 7 Copyright©2011 Cengage Learning. All Rights Reserved. Change Plan
SUMMARIZE YOUR PLANS TO IMPROVE BEHAVIORS IN THIS WELLNESS AREA
Page 3 of 7 Copyright©2011 Cengage Learning. All Rights Reserved. Change Plan
Wellness Area: Weight Management
WHAT'S YOUR READINESS STAGE IN THE AREA OF WEIGHT MANAGEMENT?
MY SELF-REFLECTION REVELATIONS: SUMMARIZED
MY BEHAVIORAL CHANGE CONTRACT
1. I, _____, have decided to engage in a Weight Management Behavior Change.
2. My Goal:
3. The Objective(s) for my indicated Goal is/are:
4. I believe the following Enabling Factors will help me accomplish my Goal:
5. I believe the following Reinforcing Factors will help me accomplish my Goal:
6. I believe the following Obstacles might prevent me from achieving my Goal:
7. If I accomplish my Goal, I will reward myself with:
8. Timeline:
Page 4 of 7 Copyright©2011 Cengage Learning. All Rights Reserved. Change Plan
SUMMARIZE YOUR PLANS TO IMPROVE BEHAVIORS IN THIS WELLNESS AREA
Page 5 of 7 Copyright©2011 Cengage Learning. All Rights Reserved. Change Plan
Wellness Area: Nutrition
WHAT'S YOUR READINESS STAGE IN THE AREA OF NUTRITION?
MY SELF-REFLECTION REVELATIONS: SUMMARIZED
MY BEHAVIORAL CHANGE CONTRACT
1. I, _____ have decided to engage in your Nutritional Behavior Change.
2. My Goal:
3. The Objective(s) for my indicated Goal is/are:
4. I believe the following Enabling Factors will help me accomplish my Goal:
5. I believe the following Reinforcing Factors will help me accomplish my Goal:
6. I believe the following Obstacles might prevent me from achieving my Goal:
7. If I accomplish my Goal, I will reward myself with:
8. Timeline:
Page 6 of 7 Copyright©2011 Cengage Learning. All Rights Reserved. Change Plan
SUMMARIZE YOUR PLANS TO IMPROVE BEHAVIORS IN THIS WELLNESS AREA
Page 7 of 7 Copyright©2011 Cengage Learning. All Rights Reserved.