Written Goal Plan Form Your First Name (required) Your Last Name (required) Your Email (required) IL PLAN (704 Reg.) WaivedAccepted Goal Outcome: (704 Req.) OngoingAchievedDropped Date Defined Outcome Date: (704 Req.) Goal Category A. Self Advocacy/Self-empowermentB. CommunicationC. Mobility/TransportationD. Community-Based LivingE. EducationalF. VocationalG. Self-CareH. Information Access/TechnologyI. Personal Resource ManagementJ. Relocation from a Nursing Home or Institution to Community-Base Living Care/NutritionK. Community/Social ParticipationL. Other Goal Type: Goal Note: Consumer Signature: (please sign below) Date of Signature:
