INDIVIDUAL PLAN – CINS/FINS
Residential Non-Residential
Participant Name:	Participant #:
Counselor Name:	Program:
Intake Date:	Plan Initiated Date:	Plans Must Be Reviewed Every 30 Days
SERVICES
Type of Services	Frequency / Duration	Location	Participant / Family / Staff / Program Responsible
**Frequency and duration of services may vary depending on unforeseen circumstances or changes/disruption in schedules
Px strengths, needs, abilities and preferences (SNAP):
S.
N.
A.
P.
Discharge Criteria/Transition Information: (critical goals to be met, or gains to be made before discharge from the program)

INDIVIDUAL PLAN – CINS/FINS
Participant Name:	Participant #:
Prioritized Issue: (1 per page, # issues 1,2,3 in priority order.)
Goal(s): (1,2,3, etc.)
Individual Plan Objectives
Goal #	Objective(s) (A, B, C, etc.) (Measurable, achievable, time specific behavioral objectives to be achieved by the participant and appropriate to the service setting.)	Specific Type of Interventions	Date Begun	Target Date(s) to be Completed	Date Completed

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INDIVIDUAL PLAN – CINS/FINS
Participant Name:	Participant #:
Please Check and Date:	New Plan	Plan Updated
I helped in the development of and agree with this plan, and have been offered a copy.
Participant’s Signature	Date
Parent or Guardian	Date
Counselor/Case Manager’s Signature/Title	Date
Supervisor’s Signature/Title	Date
Please Check and Date:	Plan Reviewed
I helped in the development of and agree with this plan, and have been offered a copy.
Participant’s Signature	Date
Parent or Guardian	Date
Counselor/Case Manager’s Signature/Title	Date
Please Check and Date:	Plan Reviewed
I helped in the development of and agree with this plan, and have been offered a copy.
Participant’s Signature	Date
Parent or Guardian	Date
Counselor/Case Manager’s Signature/Title	Date
Please Check and Date:	Plan Reviewed
I helped in the development of and agree with this plan, and have been offered a copy.
Participant’s Signature	Date
Parent or Guardian	Date
Counselor/Case Manager’s Signature/Title	Date