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Run: Individual Service Plan Goal Setting Form

An Individual Service Plan Goal Setting Form for documenting client-driven goals, action steps, supports, and target dates during ISP intake. Use it to captu...

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Client and Case Manager Information

Client ID / Case Number (required)

Enter the agency-assigned client ID. Do not use full name as the primary identifier.

Client Preferred Name (required)

Name the client uses and prefers to be called.

Client Date of Birth (required)

Required for age-appropriate goal planning and eligibility verification.

Client Primary Language (required)

If Other, specify primary language

Is an interpreter or language accommodation needed? (required)

Case Manager Full Name (required)

Case Manager Email (required)

Program / Service Unit (required)

Client Intake Date (required)

Date the client was formally enrolled. This ISP must be completed within 30 days of this date.

ISP Completion Date (required)

Date this ISP form is being completed.

Scheduled Plan Review Date (required)

Typically 90 days or 6 months from completion, per program policy.

Client Participation and Consent

How did the client participate in developing this plan? (required)

Select all methods used during the planning process.

Were there any barriers to full client participation? (required)

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? (required)

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 (required)

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 (required)

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 (required)

Select all that apply based on client report.

Current Living Situation (required)

Current Employment / Education Status (required)

Priority Life Domains (client-selected) (required)

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 (required)

Goal 1 – Goal Statement (required)

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 (required)

Goal 1 – Action Steps (required)

List each action step, who is responsible, and the due date.

Goal 1 – Supports and Services Needed (required)

Goal 1 – How Will Success Be Measured? (required)

Define observable, measurable indicators of goal achievement.

Goal 1 – Priority Level (required)

Goal 2

Does the client have a second goal to document at this time? (required)

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? (required)

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? (required)

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 (required)

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.

Yes No N/A

Client Signature (required)

Client or authorized representative signature.

Client Signature Date (required)

Case Manager Certification (required)

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.

Yes No N/A

Case Manager Signature (required)

Case Manager Signature Date (required)

Does this plan require supervisor review before finalization? (required)

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.

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