SMART Planning Form

Name *

First

Last

Email *

Phone *

May I contact you? *

What’s the best time and way to contact you? Check all that apply *

What type goal is this geared towards? *

What is the goal(s)? *

Specific: What exactly will you accomplish? *

Measurable: How will you know you have reached this goal? *

Achievable: Is this goal realistic with effort and commitment? Have you the resources to achieve it? If not, how will you get them? *

Relevant: Why is this goal significant in your life? *

Timely: When will you have this goal achieved? *

Date

Time

What is one thing you can start today or tomorrow that will start getting you closer to your goal(s)? *

Is there anything else you would like to make note of? *

Signature Below *