PERSON-CENTERED PLANNING: ANNUAL SUMMARY	Date
Client	Meeting Date with Client
Staff	Meeting Date with WSC
Services	SLC	PS-Day	PS-Qtr	LSD1	Other (specify)
Annual Report (3rd Quarter - before the SP meeting with WSC)
Before you write the Annual Report and before the SP meeting, plan with the client what he wants his goals to be, how he will work on the goals, which staff and how staff will help, time limits and frequency for each goal, how progress will be assessed, and how the client will know he has accomplished his goal.

1. List each Goal as the client wants it (his projected goal), numbering each, and showing the service that will help with each goal.

2. For each goal, by number show in the Action Plan:

Performance - what the client will do (activities, tasks, etc) to work on the goal

Strategies/Assistance - what staff will do to help the client to achieve the goal

Training Method(s) - most appropriate for the client and the goal (demonstrate, verbal prompts, physical prompts, repetition, explanation, pictures)

Frequency - how often staff will provide help/support the client

Time Limit - how long the client wants to work on the goal/when he should be finished

Assessment - how progress will be measured, including how the client will know he is making progress on the goal, his satisfaction with the goal, and the projected results of the training

3. For the Other Supports/Services Needed, state any supports and services not related to the goals needed to ensure the health, safety, and well-
being of the client. Areas include health, safety, household tasks, meal preparation, community inclusion, self care, personal growth, financial, leisure time, shopping, etc.

4. When you have completed the person-centered planning, write the goals in the Projected Goals/3rd Quarter section on the Annual Summary.
GOALS

ACTION PLAN

OTHER SUPPORTS/SERVICES NEEDED

Individual	Signature	Date
Client
Guardian
Staff
WSC