Self-Reliance Plan
Use this form to create your self-reliance plan. Your bishop, branch president, Relief Society president, elders quorum president, or other leaders can
assist you.
Member Information
Name
Step 1: What are my needs?
Immediate needs may include food, clothing, medical or emotional care, or housing. Longer-term needs may include education or improved employment. Identify your
needs in the space below.
Step 2: What are my income and expenses?
Monthly income
Income from all household members
Other financial sources (family, others)
Government assistance (financial, food, housing, and so forth)
Total
Monthly expenses
Tithes, offerings Debt payments
Food Clothing
Housing Electricity, fuel
Other (specify)
Water
Other (specify)
Medical
Other (specify)
Transportation
Other (specify)
Education
Total
Expenses that can be reduced or eliminated
Total
Note: The collection and sharing of data is subject to the Church’s data privacy policy, which you can view at
© 2018 by Intellectual Reserve, Inc. All rights reserved. 9/18. PD60007387 000
Self-Reliance Plan—continued
Name
Step 3: What other resources are available?
Individual resources and skills
Help and resources available from family members (parents, children, siblings, others)
Relevant community resources
Step 4: What is my personal or family plan to become more self-reliant?
As part of your plan, consider participating in a self-reliance group.
Resources and skills needed to become self-reliant Steps to be taken By when
Step 5: What work or service will I contribute in return for any assistance I may receive?
Ideas to share with the bishop or branch president
After consulting with the bishop or branch president, describe the work or service assignment you will do
Commitment
Member’s signature Date
Spouse’s signature Date
2 9/18. PD60007387 000
