Module 4 Healthy Living Check-In Form 2018

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Module 4 Healthy Living Project
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Module 4: Healthy Living Check-In (20 points)
Goal Setting Evaluation & Action Plan - 20 points
At this point in the Healthy Living Project, you should have completed the following:
● Module 1: Created a Semester-Long SMART Goal
● Module 2: Kept original Semester-Long SMART Goal or stated revised Semester-Long SMART Goal
● Module 3: Committed and stated the final version of your Semester-Long SMART Goal
See the Grading Criteria, which follows each question, to understand how you will be graded. Enter your
responses in the ORANGE areas provided after each question.
A. Semester-Long SMART Goal:
Original Semester-Long SMART* Goal (Copy from Module 1):
I will run on a treadmill 3 times a week for 30 minutes in the next 3 weeks.
Final Semester-Long SMART* Goal (Copy from Module 2 or Module 3 submission):
I will run on a treadmill 3 times a week for 30 minutes in the next 3 weeks.
NOTE: Failure to meet SMART criteria may result in point deduction in this
module and in future modules.
*Please use the SMART components in writing your one sentence Semester-Long SMART Goal.
(S- Specific/M- Measurable/A- Action-Oriented/R- Realistic/T- Time-Bound)
So that you have sufficient time to achieve your goal, you may not change the target
wellness-related behavior included in your Semester-Long SMART Goal after Module 2.
● If you need assistance with your SMART Goal, contact your instructor.
(When communicating via email, be sure to include your section number and your Module 1 and
proposed Module 2 SMART Goals. Allow at least 2 business days for your instructor to evaluate and
respond before the due date.)
Feedback from the modules can be found in the left column of the rubric used to grade your SMART Goal
submission.
GRADING CRITERIA
Module 4 Healthy Living Project
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A. Semester-Long SMART Goal Review (Max: 6 pts)
Included Original
Semester-Long SMART
Goal and Final
Semester-Long SMART
Goal was one-sentence
that targets one
wellness-related
behavior/concern and
includes all SMART
criteria
May or may not have
included Original SemesterLong SMART Goal; Final
Semester-Long SMART
Goal was one-sentence that
targets one wellness-related
behavior/concern but
misses 1 component of
SMART criteria
May or may not have included
Original Semester-Long SMART
Goal; Final Semester-Long
SMART Goal targets one
wellness-related behavior/concern
but misses 2 or more components
of SMART criteria OR goal is not
expressed in 1 sentence
OR goal includes more than one
target behavior
Did not include
Semester-Long
SMART Goal
6 points
4 points
2 points
0 points
B. Action Plan
An important part of the process of change is evaluating your progress and allowing for revisions.
● In the Module 1 and Module 2 Healthy Living Check-Ins, you outlined an action plan
(skills and/or strategies) to help you achieve your Semester-Long SMART Goal.
● Include the 4 specific action steps from your Action Plan in Module 1 and Module 2 (3
original from module 1 and new step added in module 2)
● OR if you changed your goal in module 2 enter the new action steps here (make sure
that action steps reflect your semester long SMART goal).
1.
I will create a scheduled alarm system on Mondays, Wednesdays, and Fridays at 7:00 PM.
2.
If I fail to go a day, I will include an extra 30-minute run on the treadmill the next exercise day.
3.
I will install a pedometer system on my phone to track the number of steps I take as encouragement.
4.
I will complete 50 squats after running on the treadmill.
GRADING CRITERIA
B. Action Plan (Max: 4 pts)
Included 4 specific action
Included 3 specific action
steps
Included 1 or 2 specific
action steps
Did not include specific
action steps
4 points
3 points
1 point
0 points
C. Adherence to Action Plan
● Are you following your Action Plan (listed above in letter I)?
Module 4 Healthy Living Project
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Choose one:
Yes
No
X
Sometimes/Some Parts
GRADING CRITERIA
C. Adherence to Action Plan (Max: 2 pts)
Indicated whether action plan was being followed
Did not indicate whether action plan was being followed
2 points
0 points
D. Explanation of Progress:
● If you ARE following your Action Plan, what steps/actions are you taking to be
successful in following your action plan? (For example, have you rearranged your
schedule to make time for the new behavior? Have you implemented any particular
strategies? Have you invited someone else to join you?)
● If you ARE NOT following your Action Plan, why and how will you address these
barriers to get back on track so you can successfully follow your Action Plan?
I’m not following my action plan consistently because I’m taking classes such as Biology with lab and Anatomy and
Physiology also with lab. In order for me to succeed in the class, I have to carve out more time for studying, especially
when this time of the year is where exams are given back to back. Despite studying, I do complete my action plan when I
have time. For example, if I understand the material in a class and I have time later that day, I’ll complete my action plan. I
know I will get back on track when I don’t have any exams in a week.
GRADING CRITERIA
D. Explanation of Progress (Max: 5 pts)
Provided a detailed explanation for YES
or NO to following action plan
Provided an explanation for YES
or NO to following action plan
but details were missing
5 points
3 points
Did not indicate whether action
plan was being followed
0 points
E. New Actions Step for Action Plan:
● As you continue through the process of changing your behavior, identify one NEW
action step to add to your Action Plan.
● Perhaps you would like to add an activity, address a barrier or adjust one of your
current action steps.
● Consider options that will help you be successful this semester!
NEW action step for Action Plan:
When I have exams within a week, I create a mini schedule for a specific day of exercising that works around my studying.
Module 4 Healthy Living Project
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**You will now have 5 Action Steps that make up your action plan.**
GRADING CRITERIA
E. New Action Step for Action Plan (Max: 3 pts)
Included appropriate new action step for
Action Plan
3 points
Included new action step, but
was not appropriate for Action
Plan
2 point
Did not include new action step
for Action Plan
0 points
This is the end of the assignment.
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