Weekly Note Form

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weekly note form

Name(Required)

Do you have any new contact information? (Phone, Email, Address)

Plan Coordinator

Date(Required)

Why was your participation in the Clubhouse this week important to you?(Required)

Why did you come to the Clubhouse this week?(Required)

Were there any goals you worked on this week?(Required)

How did the Clubhouse (staff, other members) help you with these goals?(Required)

What are the next steps you want help for to reach goals and how will the Clubhouse assist?(Required)

Anything else you want staff to know this week?

September 18, 2025

June 27, 2025

June 18, 2025