Name:

Date:

ASSIGNMENT 2: PLAN BEHAVIOR CHANGE

In a typed, double-spaced paper using 10- or 12-point font, please complete/answer the following
items (1-6). If desired, you may embed your responses in the formatted text that follows.

1) Establish Goals. Create 1 long-term goal (for six weeks from now) and 5 short-term and
intermediate goals (i.e., weekly “milestones” that you strive for on the way to your final goal).
Short-Term or “Mini” Goals (Milestones) Target Date
Week 1:
Week 2:
Week 3:
Week 4:
Week 5:

Final Goal Target Date

Week 6:

2) Chose Rewards. Make a list of activities, events, and objects you can use as rewards for achieving
each of the identified goals of your behavior-change program.
Goals Rewards
Short-Term Goal 1
Short-Term Goal 2
Short-Term Goal 3
Short-Term Goal 4
Short-Term Goal 5
Long-Term Goal

3) Anticipate Barriers. Identify two potential barriers to change (e.g., situations that may make it
harder to change) and, for each challenging situation, list one or more ideas to stay, or get back,
on track.
 Potential Barriers Strategies to Overcome Potential Barriers

4) Involve People Around You. Identify two people who may influence your target behavior and your
efforts to change it. For each person you identify, briefly describe how that person could help
with your behavior-change program. In particular, identify someone who can witness your
behavior-change plan and be willing to help motivate you to maintain your commitment to your
program.

Potential Social Support Potential Involvement in Behavior-Change Program

Person 1:
Person 2:

5) Design Monitoring System. Create a format for a log for monitoring the behavior patterns relating
to your target behavior. A sample weekly log is highlighted below.

Date Goal Goal Achieved? What Happened? New Goal/Strategy

6) Complete Contract for Change. Use the information from the previous activities (e.g., establish
goals, chose rewards, etc.) to complete the attached contract.
 Behavior Change Contract (Complete, print, & post this contract in a visible location!)

1. I (insert your name here) agree to (specify behavior you want to change; include current status).
2. I will begin on (note start date) and plan to reach my goal of (specify final goal) by (include final
target date).
3. In order to reach my final goal, I have devised the following schedule of mini-goals. For each step in
my program, I will give myself the reward listed.

Mini-goal 1 Target date Reward 1

Mini-goal 2 Target date Reward 2

Mini-goal 3 Target date Reward 3

Mini-goal 4 Target date Reward 4

Mini-goal 5 Target date Reward 5

Final Goal Target date Overall Reward

4. I have identified potential barriers for changing my behavior and developed the following strategies
to overcome them: (Note two obstacles and strategies to overcome them)
5. I will use the following tools to monitor my progress toward reaching my final goal: (Note any charts,
graphs, or logs you plan to use)
6. I have recruited a helper who will witness my contract and (list any way in which your helper will
participate in your program)
7. I sign this contract as indication of my personal commitment to reach my goal.

Your Signature Date

Witness’s Signature Date