HTML Preview Blank Army Counseling Form page number 1.
DEVELOPMENTAL COUNSELING FORM
For use of this form, see FM 22-100; the proponent agency is TRADOC
DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY:
PRINCIPAL PURPOSE:
ROUTINE USES:
DISCLOSURE:
5 USC 301, Departmental Regulations; 10 USC 3013, Secretary of the Army and E.O. 9397 (SSN)
To assist leaders in conducting and recording counseling data pertaining to subordinates.
For subordinate leader development IAW FM 22-100. Leaders should use this form as necessary.
Disclosure is voluntary.
PART I - ADMINISTRATIVE DATA
Name (Last, First, MI) Rank/Grade Social Security No. Date of Counseling
Organization Name and Title of Counselor
PART II - BACKGROUND INFORMATION
Purpose of Counseling:
(Leader states the reason for the counseling, e.g., performance/professional growth or event-oriented counseling, and
includes the leader's facts and observations prior to the counseling.)
PART III - SUMMARY OF COUNSELING
Complete this section during or immediately subsequent to counseling.
Key Points of Discussion:
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 635-200.
EDITION OF JUN 85 IS OBSOLETE
DA FORM 4856, JUN 1999
USAPA V1.00