Change Plan Worksheet

EQUIPMENT REQUIRED: Distribute a copy of this sheet to group members to help them to document their personal change plan

1. The changes I want to make are:

2. The most important reasons why I want to make these changes are:

3, The steps I plan to take in changing are:

4, The ways other people can help me are:

Person

5. I will know my plan is working if:

6. Some things that could interfere with my plans are:

7. How important is it to me to make this change?

0

1

2

3

4

5

6

7

8

9

10

8. How confident am I that I can make this change?

0

1

2

3

4

5

6

7

8

9

10