©Judith Trustone 2006

At least once a week or daily if you can, write out the following in your notebook. Take all the
space you need. Be sure to date each entry.

My goals for this day/week are:

The outcome of my efforts: _______________________________________


This is what worked:

This is what didn’ t work and what I need to re-evaluate:

An area that I need to learn more about to be successful is:

I am taking care of my health by: (diet, vitamins, stress management techniques, medical
appointments, addiction counseling, exercise etc.: ________________________

Right now I am attempting to meet my emotional needs by:

I am meeting my spiritual needs by: __________________________________

I reached beyond my comfort zone to: _________________________________

One positive new thing I learned today/this week is: _______________________

My interpersonal/family relationships are: ______________________________

I plan to improve my family relationships by: _____________________________

I had fun today/this week by: ________________________________________

One kind thing I did for another today/this week is: _________________________

Right now, this is how I feel about myself: ________________________________

I am giving back to the community today/this week by: _______________________

My financial situation is: ____________________________________________

To improve my financial situation, I need to: _______________________________

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