Sunteți pe pagina 1din 2

Individual Service Strategy

Participants Name: _____________________________________________________________________ GOALS Personal Professional

PROFIILE Description Family Background Education/Language/ Literacy Work History Referral Source Action Required

BARRIERS /SUPPORT SERVICES Description Income Basic Needs (Food, Clothing) Housing Action Required

Health Care Child Care Transportation Legal Issues Counseling/Mental Health Other (specify) SUPPORTS AND STRENGTHS Supports Strengths

I participated in the development of this plan and agree that this plan accurately reflects my current life goals, needs, strengths and supports. I agree to participate in the plan and goals set above, and I will maintain contact with my case manager at least once a weekly until employed. I understand the attendance and performance requirements expected of me throughout this entire program. I further understand that this plan may be modified. I will notify my case manager of any and all changes in circumstances.

Participant Signature ________________________________

date _______________________

Case Manager Signature ________________________________ date _______________________

S-ar putea să vă placă și