Person Centered Employment Plan Form Page 7

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My Person-Centered Planning Tool
Participant Name
Date
This planning tool is a discovery tool that is used to guide the person centered planning
process and assist in the development of a participant’s employment plan.
Who is in my team?
ROLE
NAME
PHONE/EMAIL
AGENCY
Participant
Guardian
Family
Family
Friends
Case Manager
Employment Specialist
Direct Care Staff
Direct Care Staff
Other:
Other:
Person Centered Employment Plan
7
REV 6/2014

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