SE Annual Summary

IP Effective Date*

MonthDayYear
Date
Support Plan Effective Date*

MonthDayYear
Date
Date Sent to WSC*

MonthDayYear
Date
Date Sent to Individual*

MonthDayYear
Date
Life Skills Development 2 (Supported Employment)
Individuals Name*
Coach*
Year*
Goal*
Places of Employment if unemployed places individual applied and received an interview*
Strengths Weakness Job Preferences*
If applicable Work performances
Job development activities*
Summary of last three quarters*
Progress towards achieving goals*
Attempts made towards goals*
Need for ongoing support*
Individual Rights Training provided*
Signature*
Date*

MonthDayYear
Date
Should be Empty: