Personal Action Plan

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PERSONAL ACTION PLAN
Name: __________________________
Date: ______________________________
1. Goals: Something you WANT to do:
2.
Positive Outcomes for my life:
3.
Describe Action Plan (steps to achieve goal):
What: _______________________________________________________________
When: ______________________________________________________________
Where: _____________________________ How often: ______________________
Start date: ___________________________________________________________
4.
Challenges/Obstacles:
5.
Plans to overcome challenges:
6.
Support and resources to achieve goal:
____________________________________________________________________
7.
How sure are you that you can reach your goal?
0
1
2
3
4
5
6
7
8
9
10
Totally unsure
Somewhat sure
Extremely sure
8.
Follow-Up: _______________________________________________________

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