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Individuals (add multiples names seperated by a coma ',')
1. My discussed responsibilities for the upcoming week are:
2. On goings in the household that I am satisfied with (ex.Housemates, Food Menu, Environment, Procedures etc.):
3. On goings in the household in which I would like to see changes made:
4. My accomplishments for the past week:
5. Things I need:
1. What i did at School/Work this week:
2. Things in School/Work that I am satisfied with (ex. Transportation, Co-workers/Classmates, Curriculam/Tasks, Environment, Supervisors etc.):
3. Things in School/work that I have concerns about:
1. My Interest and Preferences are:
2. Activities I would like to participate in this upcoming week/weekend:
3. What activities did I participate in this past week:
Additional Comments (to be filled out by the Staff if needed):
Follow Up Action (to be filled out by Coordinator)
Staff Name