Specific or short-term goals (include current status for each)
General or long-term goals
B. My program plan is as follows:
C. My program will begin on (date) . My program includes the following schedule of mini-goals. For each step in my program, I will give myself the reward listed.
D. My program will include the addition of physical activity to my daily routine (such as climbing stairs or walking to class):
E. I will use the following tools to monitor my program and my progress toward my goals: (list any charts, graphs, or journals you plan to use)
I sign this contract as an indication of my personal commitment to reach my goal.
(your signature) ________________________________________ (date) _________________________
I have recruited a helper who will witness my contract and (list any way your helper will participate in your program)