INDIVIDUAL SERVICE PLAN

Client Name: _____ Date of Intake: / /

Case Manager: Client DOB: / /

Part 1: Health and Wellness

Goal Strategies/Steps Target Dated Notes

Date Achieved
1. Maintain 1.
Sobriety
2.

3.
4.

5.
2. Mental health

3. Family
Reunification
2.

3.
4.

5.

Client Strengths:

Client Obstacles:

Progress Summary:
 Client Name:_________________

Part 2: Employment and Financial Stability

Goal Strategies/Steps Target Date Notes

Date Achieved
1. Obtain 1.
Employment
2.

3.

4.

5.
2. Maintain 1.
Employment for
Minimum of 6 2.
Months
3.

4.

5.
3. Repair credit 1.
history.
2.

3.

4.
4. Financial 1.
Stability
2.

3.

4.
5.

6.

Client Strengths:

Client Obstacles:

Progress Summary:
______

2
 Client Name:_________________

Part 3: Housing Stability

Goal Strategies/Steps Target Date Notes

Date Achieved
1. Rebuild Housing 1.
History
2.

3.

4.

5.
2. Permanent 1.
Housing
2.

3.

4.

5.

5.

Client Strengths:

Client Obstacles:

Progress Summary:

____________________ ______________________________________
Case Manager Signature Date Director Signature Date

_______________
Client Signature Date