Alternative Consultation, Counseling & Training

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How I Feel

I am feeling ______________________________ now (remember you can have more than one feeling at a time)

I feel this way because__________________________________________________

Complete the next page.

What I Can Do

I am:

𐂆 Thinking about what to do next

𐂆 Ready to get started

𐂆 Already doing the following

I am focusing on the following long-term goal:

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My immediate goal is: (Be specific about what, when, how and where)

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I will ask (Who?) ___________________ for support and they can help me by:

(Be specific about what will be helpful to you)

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I will know I am making progress on my goal by:

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When I reach my short-term goal my reward will be: __________________________________________________________________

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Signature                                                                  Date