Community Reinvestment Reintegration Plan Form
Complete this form to outline and support a participant’s reintegration into the community through structured goals, services, and follow-up. All information is used solely for planning purposes.
Participant Full Name
*
First Name
Last Name
Participant Contact Information (Email or Phone)
*
Current Status and Primary Needs
*
Please Select
Seeking housing
Employment support needed
Mental health support
Substance recovery support
Family reunification
Other
Primary Program or Service Goals
*
Support Services Required
*
Housing assistance
Job training or placement
Healthcare access
Counseling/therapy
Transportation support
Other
Target Timeline for Reintegration
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preferred Meeting Cadence for Check-ins
*
Weekly
Bi-weekly
Monthly
Other
Potential Barriers to Successful Reintegration
Lack of stable housing
Limited employment opportunities
Health or mental health challenges
Transportation difficulties
Lack of social support
Other
Case Manager Follow-up Notes or Next Steps
Submit Reintegration Plan
Should be Empty: