TRANSITION SESSIONS

TRANSITION SESSIONS
PARTICIPANT NAME*
SESSION DATE*

MonthDayYear
Date
TOPIC
Time
In*
Out*
1. EMPLOYMENT*

EmployedUnemployedInterviewingMailing ResumesNewspaper
Comments*
2. FAMILY RELATIONSHIP*

SameImprovingIncreased CommunicationIdentifying Problems
Comments*
3. COMMUNITY RESOURCES*

Edd OfficeChurchCounty ProgramsWork/Education Schools
Comments*
4. SELF-HELP GROUPS*

NoneAttending: AACACODAOtherWeeklyBi-Weekly
Comments*
5. Personal Goals: improvement in*

Positive ThinkingBehaviorAttitudeSober Lifestyle
Comments*
6. RELAPSE PREVENTION*

Identifying RiskLifestyle ChangesRecognizing Symptoms
Comments*
ADDITIONAL COMMENTS*
I UNDERSTAND THAT ALCOHOL IMPAIRS MY ABILITY TO DRIVE AND IUNDERSTAND THE DANGEROUS CONSEQUENCES OF DRIKING AND DRIVING.
Signature*

Clear
Email*
example@example.com
DATE*

MonthDayYear
Date
Location*
The bottom portion of this form will be completed by an employee of Jackson Bibby.

Please leave blank.
ATTITUDE

EnthusiasticCooperativePassive-resistantUncooperative
BEHAVIOR:

Appropriate; aware of responsibilities as group memberBehaves appropriately in groupUnsure of group member roleInappropriate; disruptive to group process
COMMUNICATION

Extremely verbalModerately communicativeQuiet; responds when askedNo communications
GROUP LEADER
DATE

MonthDayYear
Date
On submitting the form, the form(s) will be emailed directly to Jackson-Bibby.
Should be Empty: