Family Action Plan Worksheet — AJFC

Family Action Plan Worksheet

AJFC Community Action Agency, Inc. • Appendix N

Describe your goal, what may stand in the way, and the steps you will take. Complete this worksheet with your caseworker when possible.

Your entries are not submitted to AJFC or saved by this worksheet. Print or save a PDF before leaving or refreshing the page. Do not enter Social Security numbers.

Client name Date completed

Client Goal Barrier(s) Strengths / Resources

Action Steps

Identify the action, responsible person, target date, evidence of progress, and current status.

Action Step 1

Action Step Responsible Person Target Date Evidence of Progress Status

Action Step 2

Action Step Responsible Person Target Date Evidence of Progress Status

Action Step 3

Action Step Responsible Person Target Date Evidence of Progress Status

Action Step 4

Action Step Responsible Person Target Date Evidence of Progress Status

Action Step 5

Action Step Responsible Person Target Date Evidence of Progress Status

Choose “Save as PDF” in your browser’s print window to save a copy. If the printing button is unavailable, use your browser’s Print command: Ctrl+P on Windows or Command+P on Mac. Share the completed copy with your caseworker using AJFC’s approved method. Your typed name is not an electronic signature.

Big ideas, real impact.