Developmental Counseling Record by vef11fF0


									                                    DEVELOPMENTAL COUNSELING FORM
                                                     For use of this form see FM 22-100.
                                    DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY: 5 USC 301, Departmental Regulations; 10 USC 3013, Secretary of the Army and E.O. 9397 (SSN)
PRINCIPAL PURPOSE: To assist leaders in conducting and recording counseling data pertaining to subordinates.
ROUTINE USES: For subordinate leader development IAW FM 22-100. Leaders should use this form as necessary.
DISCLOSURE: Disclosure is voluntary.
                                          PART I - ADMINISTRATIVE DATA
Name (Last, First, MI)                        Rank / Grade            Social Security No.           Date of Counseling
             Tricker, Tyler N.                     PFC / E-3                  613-10-1180               29 July 2005
Organization                                                          Name and Title of Counselor
B Co. STB, 2D Infantry Division, APO AP 96258                                      SPC Chrysler / Team Chief
                                     PART II – BACKGROUND INFORMATION
Purpose of Counseling: (Leader states the reason for the counseling, e.g. Performance/Professional or Event-Oriented
counseling and includes the leaders facts and observations prior to the counseling):

Monthly performance counseling for July

                                          Physical Fitness                           Promotions
                                          Personal appearance                        Manage of Finance
                                          Personal accountability                    Safety/Drinking

                                       PART III – SUMMARY OF COUNSELING
                           Complete this section during or immediately subsequent to counseling.

Key Points of Discussion:

PFC Tricker, this is your counseling for the month of July. You are very good at your job and you proved it this month
during crew drills. Your team received the best time out of any other V3 team in the division. Continue doing what you
are doing and you will have a very successful and enjoyable military career.

Physical Fitness: PT us a personal responsibility, even thought we do PT 5 days a week, there is no way we can make a
program that will successfully better everyone’s scores. You have to work on your weakest events on your own if you
need any help feel free to ask me and I will do everything within my power to help you.

Promotions: You still have some time in service until your able to make SPC. However you should consider trying to
earn promotion points for when you are at the stage to make SGT. Doing correspondence courses online is a great way to
earn points and with your current rank you still have very little responsibility giving you more free time to do things like
this. Now is the best time before you are promoted to SPC and at another duty station where earning points is not as easy
as it is here.

Personal Appearance: Your uniform and boots have met the standard set forth in AR 670-1. Keep up the good work.

Manage of finance: In order to keep your personal finances personal, pay all of your bills on time or early. If you find
yourself in a bind call your creditors and let them give you a chance to catch up.

Personal Accountability: It is your responsibility to keep me informed of your whereabouts at all times. If there is for any
reason you are going to miss or be late to a formation or work call it is up to you to make me aware of the situation.

Safety / Drinking: The drinking age in South Korea is 21. You are not 21 years of age. If you are caught drinking under
age UCMJ action will be taken. This is beyond my control and I cannot help you if this action occurs. My advice for you
is to not drink. All in all be safe and responsible in all that you do because you are a soldier 24 hours a day, 7 days a
week. Lastly thank you for a safe and productive month.

                                              OTHER INSTRUCTIONS
This form will be destroyed upon: reassignment (other than rehabilitative transfers), separation at ETS, or upon
retirement. For separation requirements and notification of loss of benefits/consequences see local directives and AR 635-
DA FORM 4856, JUN 1999                      EDITION OF JUN 85 IS OBSOLETE                                    USAPA V1.00

Plan of Action: (Outlines actions that the subordinate will do after the counseling session to reach the agreed upon goal(s).
The actions must be specific enough to modify or maintain the subordinate’s behavior and include a specific time line for
implementation and assessment (Part IV below):

No plan of action at this time.

Session Closing: (The leader summarizes the key points of the session and checks if the subordinate understands the plan of
action. The subordinate agrees/disagrees and provides remarks if appropriate):
Individual counseled: I agree  / disagree  with the information above

Individual counseled remarks:

Signature of Individual Counseled: __________________________________Date: ____________________

Leader Responsibilities: (Leader’s responsibilities in implementing the plan of action):

Signature of Counselor: _______________________________________Date: ________________________
                               PART IV - ASSESSMENT OF THE PLAN OF ACTION
Assessment: (Did the plan of action achieve the desired results? This section is completed by both the leader and the
individual counseled and provides useful information for follow-up counseling):

Counselor: ____________________        Individual Counseled:_________________ Date of Assessment: ______________
        Note: Both the counselor and the individual counseled should retain a record of the counseling.
DA FORM 4856-E (Reverse)

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