SHOPPING LIST

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SHOPPING LIST

SECTION C: KNOWLEDGE OF SELF

 

[_] GOAL: [__/_] ______________________________________________________

  • [_] Pre-contemplation:    There is no intention to change behavior or belief regarding opportunities to achieve success.
  • [_] Contemplation:          Initiate Recognizing behavior. Thought about changing, deciding to commit to changes.
  • [_] Planning/Preparation: Refine Intends to change. Getting ready has spoken about changing. Expressed to others what “I” am going to be doing differently.
  • [_] Changed a habit:       Transformation
  • [_] Maintenance:             Power “I” am comfortable with changes that “I” made, & have maintained for at least 28 days. A plan has been developed & “I” have maintained a routine I am confident with, in order to attain another level:

PLANS TO ACHIEVE SET GOAL:

Completed Steps # _______________________________________________

  • [_] a:# __ ________________________________________________ [_/_/_]
  • [_] b:# __ ________________________________________________ [_/_/_]
  • [_] c:# __ ________________________________________________ [_/_/_]
  • [_] d:# __ ________________________________________________ [_/_/_]

[_] Relapse: Discontinued change,reverted back [_] Repeat 

SOCIALIZING OUR YOUTH BUILDING FAMILY HEALTH & EDUCATION  

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*(workshop students who attended workshop/class & signed attendance sheet receive student consultation rate:  $10 per 10 minutes at time of event)

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