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Here is an example. Do not copy this example. It just to help you. Pick a different example you want to do.
2015 Pearson Education Inc
Behavior Change Contract
My behavior change will be:
To snack less on junk food and more on healthy Goods.
My long-term goal for this behavior change is:
Eat junk food snacks no more Than once a week
These are three obstacles to change (things that I am currently doing or situations that contribute to
this behavior or make it harder to change):
1. The grocery store is closed by The Time I come home from school
2. I get hungry between classes, and The vending machines only carry candy bars.
3. IT's easier To order pizza or other snacks Than To make a snack at home.
The strategies I will use to overcome these obstacles are:
1. I'll leave early for school once a week so I can stock up on healthy snacks in The morning..
2. I'll bring a piece of fruit or other healthy snack To eat between classes.
3. I'll leam some easy recipes for snacks To make at home.
Resources I will use to help me change this behavior include:
a friend/partner/relative: my roommates: I'll ask Them To buy healthier snacks instead of chips when They
do The shopping
a school-based resource: The dining hall: I'll ask The manager To provide healthy foods we can Take..
To eat between classes.
a community-based resource. The library: I'll check out some cookbooks To find easy snack ideas.
a book or reputable website: The USDA nutrient doTabase of www.ars.usda.gov: I'll use This site
To make sure The Goods I select are healthy choices.
In order to make my goal more attainable, I have devised these short-term goals:
short-term goal Eat a healthy snack 3 Times per week
short-term goal Leam To make a healthy snack
short-term goal Eat a healthy snack 5 Times per week
target date September 15
target date October 15
target date November 15
When I make the long-term behavior change described above, my reward will be:
ski lift Tickets for winter break
target date: December 15
reward new CD
reward cert Tickets
reward new shoes
I intend to make the behavior change described above. I will use the strategies and rewards to achieve
the goals that will contribute to a healthy behavior change.
Signed: Elizabeth King
Witness: Susan Baver
Transcribed Image Text:2015 Pearson Education Inc Behavior Change Contract My behavior change will be: To snack less on junk food and more on healthy Goods. My long-term goal for this behavior change is: Eat junk food snacks no more Than once a week These are three obstacles to change (things that I am currently doing or situations that contribute to this behavior or make it harder to change): 1. The grocery store is closed by The Time I come home from school 2. I get hungry between classes, and The vending machines only carry candy bars. 3. IT's easier To order pizza or other snacks Than To make a snack at home. The strategies I will use to overcome these obstacles are: 1. I'll leave early for school once a week so I can stock up on healthy snacks in The morning.. 2. I'll bring a piece of fruit or other healthy snack To eat between classes. 3. I'll leam some easy recipes for snacks To make at home. Resources I will use to help me change this behavior include: a friend/partner/relative: my roommates: I'll ask Them To buy healthier snacks instead of chips when They do The shopping a school-based resource: The dining hall: I'll ask The manager To provide healthy foods we can Take.. To eat between classes. a community-based resource. The library: I'll check out some cookbooks To find easy snack ideas. a book or reputable website: The USDA nutrient doTabase of www.ars.usda.gov: I'll use This site To make sure The Goods I select are healthy choices. In order to make my goal more attainable, I have devised these short-term goals: short-term goal Eat a healthy snack 3 Times per week short-term goal Leam To make a healthy snack short-term goal Eat a healthy snack 5 Times per week target date September 15 target date October 15 target date November 15 When I make the long-term behavior change described above, my reward will be: ski lift Tickets for winter break target date: December 15 reward new CD reward cert Tickets reward new shoes I intend to make the behavior change described above. I will use the strategies and rewards to achieve the goals that will contribute to a healthy behavior change. Signed: Elizabeth King Witness: Susan Baver
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