Change Tracker And

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 from the document before submitting it to your instructor.

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:

SUMMARIZE YOUR PLANS TO IMPROVE BEHAVIORS IN THIS WELLNESS AREA

Wellness Area: Weight Management

WHAT'S YOUR READINESS STAGE IN THE AREA OF WEIGHT MANAGEMENT?

1. I, _____, have decided to engage in a Weight Management Behavior Change.

2. My Goal:

8. Timeline:

Wellness Area: Nutrition

WHAT'S YOUR READINESS STAGE IN THE AREA OF NUTRITION?

1. I, _____ have decided to engage in your Nutritional Behavior Change.

2. My Goal:

8. Timeline: