Behavior Change Contract

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Behavior Change Contract

Choose a health behavior that you would like to change, starting this quarter or semester. Sign the contract at the bottom
to affirm your commitment to making a healthy change and ask a friend to witness it.

My behavior change will be:


Get more Sleep. Last week I averaged about 6.45 houres and would like to get 7 to 8 every night.
My long-term goal for this behavior change is:
Feel more rested and get to sleep at an earler time.

Barriers that I must overcome to make this behavior change are (things that I am currently doing or situations that
contribute to this behavior or make it harder to change):

Being on my phone late at ningt.


Not getting things set out for the the next day. I am having to get up earlier to get things ready.
When not on phone I will be watching the telivition while I am laying in bed.

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The strategies I will use to overcome these barriers are:

Put down my phone at 11:30 every night.


Turn off the T.V. at 11:30 every night.
Get things set out and ready for the next day.

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Resources I will use to help me change this behavior include:

a friend/partner/relative: I will have my wife help keep me on track.


a school-based resource: I can use the gym at the school to get exercise and that can help me feel tired at night.
a community-based I can use the gym by my house when I am not a school to workout at .
resource: I can reread Microresolution Small Move Big Change.
a book or reputable website:

In order to make my goal more attainable, I have devised these short-term goals.

Start getting stuff ready for the next day at 9pm 15-Feb-18 One free food day.
Short-Term Goal Target Date Reward
Move phone from my nightstand to the bathroom. 10-Feb-18 Date night with wife.
Short-Term Goal Target Date Reward
No more hitting snooze on my alarm in the morning. 5-Feb-18 New hat.
Short-Term Goal Target Date Reward

When I make the long-term behavior change described above, my reward will be:
Behavior Change Contract
New workout shoes. Target Date: 28-Apr-18

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: Steven Davis 1-31-18 Witness: Raschelle Davis 1-31-18


1.00 Date 1.00 Date
Contact # Contact #

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