Forms for Sessions 3 Through 9

During the skill-building sessions, the counselor and client review or complete several forms. These forms are provided on the remaining pages of this section.

Form 3A

Problem Checklist

Category Describe Problem Severity Goal

(1–10)*

Housing/shelter

Childcare

Transportation

Financial support

Job training or

Employment

Medical problems

Legal problems

Family problems

Social or interpersonal

Problems

Social support

Emotional or psychological

Problems

Education

Other

Form 3B

Support Plan

Goal 1 Goal 2 Goal 3

What are my goals?

Who is to be contacted?

(Phone numbers and

addresses)

When will the contact

be made?

Who is responsible for

contacting?

What services will be

requested?

Outcome

Others who can help with the plan: __________________________________________

__________________________________________

__________________________________________

__________________________________________

_________________________________

Signature