Name: _Elizabeth Ashley Davis ______________________________
__ Date: _November 3______________________ (2014)
Weekly Evaluation Week# 1 2 3 4 5 6 â circle
Turn in this sheet with your chart each week. Describe your progress and behavior change activities for the past week (circled above). No late papers will be accepted (please do not ask me if you can turn them in late).
Did you achieve your process goal this week? Yes or No (â circle one)
What was your process goal for this week? Be specific! Goals must be measurable and quantifiable.
_this week I wanted to try to not drink any pop at all because of my upcoming perormance. This did not happen _______________________________________________________________________________________
What is your outcome goal at the end of 6 weeks? Be specific! Goals must be measurable and quantifiable.
I want to drink 0 pops and break my habit. ________________________________________________________________________________________
List a key incentive, benefit, or other positive reason for wanting to achieve my goal listed above:
Personal Incentive: I want to break this habit because pop contains may ingredietnts that are not very healthy.
That's My Goal
Goal II: Living the Dream
An incentive spirometer. The inhalation nozzel is ...Water is so much better for the body. _____________________________________________________________________
List a key barrier, or impediment that got in my way to prevent me from achieving my goal this week:
Perceived Barrier: The temptation of snacks around me as well as a busy schedule that better allows a fast food meal rather than something heaelthy. If I go out to eat I tend to want a pop with it. _____________________________________________________________________
This week, did 1-2 people encourage me to achieve my goal and provide a positive sense of support? Who?
Sense of Support: Yes or No __________________________________________________________
This week, did the expectations of my peers or friends help or hinder me reaching my goal? Describe.
Perceived Norm:__Yes, I ate out many times with...