PPW Healthy Behavior Goal Plan/Contract
This Goal Plan/Contract takes about 5 minutes to complete
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1. What is today's date? *
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2. First Name (Optional)
3. Are you...

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4. How old are you? *
5.  What is one area of your life you want to improve during this program? *
Required
6.   What support do you need to reach your goal? *
Required
7. Which of the following do you pledge to avoid or reduce during the next 7 days in order to maintain an active and healthy lifestyle? *
8. Which one of the following healthy habits will you focus on improving during the next 7 days. *
9.  From the healthy habit you identified, now write a specific, measurable and attainable healthy habit goal you will achieve over the next 7 days.  

SMART Goal
Specific
Measurable
Action-oriented / Achievable
Relevant
Time-bound  

1. Sleep goal

I will get at least 8 hours of sleep on school nights at least 4 nights per week for the next 30 days so I can improve my focus, mood, and energy.

2. Stress management goal

I will practice one stress-reducing activity, such as deep breathing, journaling, or walking, for at least 10 minutes 3 times a week for the next 4 weeks so I can better manage stress.

3. Healthy eating goal

I will eat at least 1 healthy meal or snack with fruit, vegetables, or protein 5 days a week for the next month so I can improve my health and energy.

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10.  From the healthy habit you identified, answer the following questions:

A. How will you measure success?

Help text: Include a number, frequency, or clear result. Example: attend 4 sessions, submit 3 assignments, improve attendance.

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11.  From the healthy habit you identified, answer the following questions:

B. Why is this goal important to you?
Help text: Explain why this matters for your future, school, health, or personal growth.

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12.  From the healthy habit you identified, answer the following questions:

C. What steps will you take to reach this goal?
Help text: List 2–3 actions you will take.

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13.  From the healthy habit you identified, answer the following questions:

D. List where you will engage in the healthy behavior. (Specific location).

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14.  From the healthy habit you identified, answer the following questions:

E. List with whom you will engage in the healthy behavior. (For example, a friend, family member, alone):

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15.  From the healthy habit you identified, answer the following questions:

F. Who will you share your goal with? Sharing your goal will increase your motivation to follow through with your plan.

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Required
16. Where will you post your goal plan so you can see it every day and be reminded to monitor your health habits? Choose one.
Clear selection
 Congratulations! You have successfully completed a Prevention Plus Wellness program goal plan.

· Don't forget to print out and post your goal plan and attached calendar where you can see it every day and check-off each day you reach a goal.

· At the end of your 7-day goal plan return to this site and write another goal plan to continue to make small changes to feel and look better.

· Reward yourself with small things you enjoy like magazines, music, books, watching a movie, playing and instrument, or doing art, for achieving one of your wellness goals, or avoiding alcohol, tobacco, e-cigarettes or illegal drug use.

Now rate the goal plan on the 5-star scale below.

PLAN TO COMPLETE INSTRUCTIONS 

 After you print out this goal plan, post and circle a response on the calendar below each day during the next 7 days to track your goal success. Then, total the number of days you reached a wellness goal. Do NOT Answer This Now.
Day 1 Goal Success:  1: Yes     2: No    3: No goal set for today
Day 2 Goal Success: 1: Yes 2: No 3: No goal set for today
Day 3 Goal Success: 1: Yes 2: No 3: No goal set for today
Day 4 Goal Success: 1: Yes 2: No 3: No goal set for today
Day 5 Goal Success: 1: Yes 2: No 3: No goal set for today
Day 6 Goal Success: 1: Yes 2: No 3: No goal set for today
Day 7 Goal Success: 1: Yes 2: No 3: No goal set for today
Week's Total Success Days (Number of "Yeses" Above) =
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