90 Day+ RESIDENT PROGRESS REPORT
Resident Name:
*
Month/Year:
*
Case Manager:
*
Date Completed:
*
Benefits & Resources
Insurance
Insurance
*
Yes
No
Type (if applicable):
SNAP/Food Benefits
SNAP/Food Benefits
*
Yes
No
Monthly Amount (if applicable):
Transportation
Current Transportation:
Current Transportation:
*
Own Vehicle
Public Transportation
Bicycle
Family/Friends
Program Transportation
Other
Notes:
Employment & Income
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Next
Employment Status:
Employment Status
*
Full-Time
Part-Time
Unemployed
Seeking Employment
Other
Employer:
Position:
Monthly Income:
Employment Notes:
Savings
Current Savings:
Expected Savings by Next Month:
Notes:
Exit / Departure Plan
What is your current exit plan?
*
Estimated Time Until Departure:
Estimated Time Until Departure
*
Less than 30 Days
30-60 Days
60-90 Days
More than 90 Days
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Have you started looking for housing?
*
Yes
No
Do you currently have any barriers to housing?
*
Yes
No
Where are you currently at with your exit/departure plan?
*
Recovery
What are you doing for your recovery?
*
Meetings
Sponsor
Outpatient Treatment
Counseling/Therapy
Step Work
Church/Faith-Based Activities
Other
Notes:
Goals
Goal #1
*
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Goal #2
*
Family & Support System
Notes:
Case Manager Notes
Case Manager Notes
*
Case Manager Signature:
*
Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Resident Signature:
*
Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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