BEHAVIOR CHANGE CONTRACT

Instructions: Read each question. Prepare a typed response directly underneath

each question, meeting the sentence minimum for each question. Save and submit
this sheet on Blackboard.

1. What is the behavior that you want to change? (Select a behavior that matters to you –
4 sentences)
2. Why do you want to change this behavior? (Be specific – 4 sentences)
3. What barriers will make it challenging for you to be successful with this changing this
behavior? (Be specific and list up to three – 4 sentences).
4. Develop a SMART goal for your behavior change. SMART is an acronym that stands for
Specific, Measurable, Attainable, Relevant, and Time based. (page 16 in your textbook
and in the Behavior Change Assignment Instructions document – 1 sentence)
5. Develop three (3) activities that you will do to support your behavior change and
SMART goal. (You may think of these activities as action steps to get started – 3
sentences total)
Examples:
 I will post my objective on the refrigerator.
 I will reward myself with my favorite magazine or my favorite album for each
successful week.
 I will sign up for an aerobic dance class at the university
 I will read a respected book on running.

Type your name and date below to seal your contract.

________________________________ __________________

Name Date

To make sure that your SMART goal is correct, it must be approved before you
begin your daily log and weekly journal.