SayPro Success Story Form

Purpose:
This form is used to document and share success stories that highlight the positive impact of SayPro’s services on clients. These stories will be shared internally to inspire the team and externally for marketing, advocacy, and funding purposes (with client consent).

Client Information
(This section will remain confidential. Only use the client’s first name or initials in public-facing stories unless otherwise agreed upon.)
 

• Client’s Full Name (optional):
• Client’s First Name or Initials (for confidentiality):
• Age:
• Gender (optional):
• Location (City/Region):
• Date of Service Start:
• Date of Service End (if applicable):

1. Brief Overview of the Client’s Situation
   (Provide a short summary of the client’s circumstances before receiving services. Include any challenges or obstacles the client was facing.)
    

• Challenges Faced (e.g., disability, mental health struggles, housing insecurity, etc.):
• Client’s Needs:
• Referral Source: (How did the client come to SayPro? Was it through self-referral, a family member, or another organization?)

2. Services Provided by SayPro
   (Describe the specific services and interventions provided to the client, including any notable programs, therapies, or resources offered.)
    

• Services Delivered:
  (Check all that apply)
  •  Disability Support
  •  Mental Health Services
  •  Job Training/Employment Support
  •  Housing Assistance
  •  Family Support
  •  Case Management
  •  Other (please specify):
• Key Interventions:
  (Describe any critical steps taken or strategies implemented during the client’s involvement with SayPro, including any collaborative work with other professionals or agencies.)

3. Achievements and Progress
   (Share the outcomes the client has experienced as a result of SayPro’s support. Include both qualitative and quantitative data when possible.)
    

• Goals Achieved:
• Skills Developed:
• Improvement in Quality of Life:
• Positive Feedback from Client: (Include any quotes or comments from the client about their experience with SayPro, if available.)

4. Client’s Reflection on the Impact of SayPro Services
   (This section captures the client’s perspective on how SayPro services helped them. Use the client’s own words, if possible.)
    

• Client’s Quote:
  (If the client agrees, include a direct quote or statement from them regarding their experience with SayPro services.)

5. Support from SayPro Staff or Team
   (Highlight how SayPro staff or team members made a difference in the client’s journey. Mention any key interactions, qualities, or professional approaches that were particularly effective.)
    

• Key Staff or Team Involvement:
• Effective Approaches Used:
• Client’s Relationship with the Team: (Describe the nature of the relationship between the client and SayPro staff, including trust-building and rapport.)

6. Long-Term Outcomes & Future Plans
   (Discuss the expected long-term impact of the services on the client’s future. If applicable, mention any ongoing support or follow-up.)
    

• Client’s Future Plans:
• Next Steps:
• Ongoing Support Needs:

7. Client’s Consent to Share Story
   (Check the appropriate box to indicate whether the client has consented to the sharing of their story publicly or internally.)
    

•  Client has given consent to share their success story publicly (on websites, social media, fundraising materials, etc.).
•  Client has given consent to share their success story internally (within SayPro newsletters, meetings, or reports).
•  Client prefers to keep their story confidential.

Client Signature: _______________________
Date: _______________________

8. Additional Comments or Notes
(Any other relevant information about the client’s journey, or additional insights that may add value to the success story.)

• Additional Notes:
  
  Submitted By
• Name of the Social Worker/Case Manager:
• Date Submitted:
• Contact Information:

Note: All information shared in this success story will be handled with the utmost confidentiality, and client consent is essential before any public sharing. The goal is to inspire and inform others about the positive impact of SayPro’s services while respecting client privacy.