Early Learning Family Strengths and Goal Planning

Family Vision for the Future: Click or tap here to enter text.

SMART Goal: Click or tap here to enter text.

☐ Specific	☐ Measurable	☐ Attainable	☐ Relevant	☐ Time Bound

Bridge Pillar:	☐ Family Stability – Housing	☐ Well-Being – Health & Mental Health	☐ Financial – Debt	☐ Education & Training

☐ Family Stability – Family & Dependents	☐ Well-Being – Personal & Professional Networks	☐ Financial – Savings	☐ Employment & Career Mgmt.

New or Revised Goal?	☐ New ☐ Revised

Next Steps (Help Family Brainstorm, Then Choose Steps To Take)	By When?	Family Strengths and Resources	Barriers or Concerns	Motivation	Date Step Was Completed
1. Click or tap here to enter text.	Click or tap to enter a date.	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap to enter a date.
2. Click or tap here to enter text.	Click or tap to enter a date.	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap to enter a date.
3. Click or tap here to enter text.	Click or tap to enter a date.	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap to enter a date.
4. Click or tap here to enter text.	Click or tap to enter a date.	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap to enter a date.
If Goal Target Date Extended, New Target Completion Date:	Click or tap to enter a date.

Participant Name: Click or tap here to enter text.	Signature: Click or tap here to enter text.	Date: Click or tap to enter a date.
Family Support Staff: Click or tap here to enter text.	SignatureClick or tap here to enter text.	Date: Click or tap to enter a date.

Next meeting time, date and place:Click or tap here to enter text.	Best time to contact family: Click or tap here to enter text.

Notes: Click or tap here to enter text.

Please complete when goal is completed, revised or discontinued. If revised or discontinued, please provide reason:

☐ Goal was achieved by original target date: Date Achieved: Click or tap to enter a date. ☐ Goal was achieved by extended target date: Date Achieved: Click or tap to enter a date. ☐ Goal was terminated. Date Discontinued: Click or tap to enter a date. ☐ Goal was revised. Created a revised goal worksheet

Reason for goal revision or discontinuation: Click or tap here to enter text.

OPTIONAL BRAINSTORMING WORKSHEET
Brainstorm a list of Action Steps that you would need to take to achieve your goal. To start, don’t worry about the order you write them. Once you have completed the full list, go back and number them in order.
Click or tap here to enter text.
What challenges could keep you from achieving your goal? What strategies could you use to overcome them and what resources can help you?
CHALLENGES	STRATEGIES/RESOURCES
Click or tap here to enter text.	Click or tap here to enter text.
On a scale from 1-10, how CONFIDENT are you in being able to achieve this goal?
☐1	☐2 Not At All Confident	☐3	☐4	☐5 ☐6 Somewhat Confident	☐7	☐8	☐9 Very Confident	☐10