Jump Start Week 5 Worksheet

Jump Start Week 5 Worksheet

Please complete this form as part of week 5 of the Jump Start program. If you have any questions, please contact Lindsay Worley at lworley@quadmedical.com.
Name*

First NameLast Name
Email*
example@example.com
Create an Accountability Plan
Write down your strengths and difficulties as they relate to engaging in and maintaining physical activity.
My strengths: *
My difficulties: *
Complete the following statements to make a declaration focusing on what you want to accomplish and why.
I want to build on my strength of blank* in order to blank*.
I want to improve blank* in order to blank*.
Determine how your accountability partner(s) can help support you- be specific.
What do you need support with?*
How can your partners help with supporting your needs?*
Complete the following statement to make a declaration focusing on how you want to receive support.
I would like support in the form of blanks in order to blank.
Determine who will be your accountability partner. Establish a timeline to review your goals.
My accountability partner(s) is(are):*
The days, times, and frequency that I'll meet with my accountability partner(s).*
The location or mode of communication we'll use to go over my goals.*
i.e. text, my house, Facetime, breakroom
Should be Empty:

Create an Accountability Plan