Individual Service Plan Goal Setting Form

Documents client-driven goals, action steps, target dates, and supports for a structured Individual Service Plan (ISP). Completed by case managers within 30 days of intake to ensure person-centered planning.

Client and Case Manager Information

• Client ID / Case Number
  Enter the agency-assigned client ID. Do not use full name as the primary identifier.
• Client Preferred Name
  Name the client uses and prefers to be called.
• Client Date of Birth
  Required for age-appropriate goal planning and eligibility verification.
• Client Primary Language
• If Other, specify primary language
• Is an interpreter or language accommodation needed?
• Case Manager Full Name
• Case Manager Email
• Program / Service Unit
• Client Intake Date
  Date the client was formally enrolled. This ISP must be completed within 30 days of this date.
• ISP Completion Date
  Date this ISP form is being completed.
• Scheduled Plan Review Date
  Typically 90 days or 6 months from completion, per program policy.

Client Participation and Consent

• How did the client participate in developing this plan?
  Select all methods used during the planning process.
• Were there any barriers to full client participation?
• Describe barriers and accommodations provided
  Include any ADA reasonable accommodations made (e.g., large print, ASL interpreter, extended meeting time).
• Is there an authorized representative or legal guardian?
• Representative Name and Role
  e.g., Jane Doe – Legal Guardian; John Smith – Power of Attorney
• Client consents to share plan information with the following parties
  Collect only minimum-necessary consent per HIPAA and agency privacy policy. Do not share with parties not listed here.

Client Strengths and Baseline Assessment

• Client-Identified Strengths
  Record strengths in the client's own words where possible (e.g., 'I am good at staying organized,' 'I have strong family support').
• Natural Supports Available to Client
  Select all that apply based on client report.
• Current Living Situation
• Current Employment / Education Status
• Priority Life Domains (client-selected)
  Ask the client which areas of life they most want to focus on. Select up to 5.
• Known Barriers or Challenges
  Document systemic, environmental, or personal barriers that may affect goal achievement.

Goal 1

• Goal 1 – Life Domain
• Goal 1 – Goal Statement
  Write the goal in the first person using the client's own words where possible. Example: 'I will obtain and maintain stable housing within 6 months.'
• Goal 1 – Target Completion Date
• Goal 1 – Action Steps
  List each action step, who is responsible, and the due date.
• Goal 1 – Supports and Services Needed
• Goal 1 – How Will Success Be Measured?
  Define observable, measurable indicators of goal achievement.
• Goal 1 – Priority Level

Goal 2

• Does the client have a second goal to document at this time?
• Goal 2 – Life Domain
• Goal 2 – Goal Statement
  Write the goal in the first person using the client's own words where possible.
• Goal 2 – Target Completion Date
• Goal 2 – Action Steps
  List each action step, who is responsible, and the due date.
• Goal 2 – Supports and Services Needed
• Goal 2 – How Will Success Be Measured?
  Define observable, measurable indicators of goal achievement.
• Goal 2 – Priority Level

Goal 3

• Does the client have a third goal to document at this time?
• Goal 3 – Life Domain
• Goal 3 – Goal Statement
  Write the goal in the first person using the client's own words where possible.
• Goal 3 – Target Completion Date
• Goal 3 – Action Steps
  List each action step, who is responsible, and the due date.
• Goal 3 – Supports and Services Needed
• Goal 3 – How Will Success Be Measured?

Crisis Planning and Safety

• Are there any identified crisis or safety risks at this time?
• Type(s) of Risk Identified
• Brief Crisis / Safety Plan
  Summarize warning signs, coping strategies, and emergency contacts. Attach full safety plan document if applicable.
• Emergency Contact Name
  Person to contact in a crisis, as designated by the client.
• Emergency Contact Phone Number
• Emergency Contact Relationship to Client

Certification and Signatures

• Client Acknowledgment
  By checking this box, the client (or authorized representative) confirms they participated in developing this plan, the goals reflect their own priorities, and they received a copy of this plan.
• Client Signature
  Client or authorized representative signature.
• Client Signature Date
• Case Manager Certification
  By checking this box, the case manager certifies this plan was developed collaboratively with the client, goals are client-driven, and the plan complies with agency policy and applicable program requirements.
• Case Manager Signature
• Case Manager Signature Date
• Does this plan require supervisor review before finalization?
  Required for clients with identified crisis risks or complex multi-agency coordination needs.
• Additional Case Manager Notes
  Any additional context not captured elsewhere in this form.