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