Developmental Counseling FORM
For
use this form, see FM 6-22; the proponent agency in TRADOC.
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DATA REQUIRED BY THE
PRIVACY ACT OF 1974
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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: The
DoD Blanket Routine Uses set forth at the beginning of the Army’s compilation
of systems or records also
apply to this system
DISCLOSURE: Disclosure is voluntary.
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Part I - Administrative
Data
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Name
(Last, First, MI)
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Rank/Grade
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Date
of Counseling
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Organization
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Name
and Title of Counselor
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PART II - Background
Information
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Purpose of Counseling: (Leader states the reason for the
counseling, e.g., Performance/Professional or Event-Oriented counseling and
includes the leader’s facts and observations prior to the counseling):
Lack of motivation
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Part III - Summary of Counseling
Complete this section during or immediately
subsequent to counseling.
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Key Points of
Discussion
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PFC XXXX this morning at around xxxx on
xxxx 2012 Zone 1. You displayed lack of motivation during Platoon Physical
Activities. These activities enhance physical fitness and readiness for the
Platoon. The Platoon Physical activities can be used to promote unit esprit
de corps and teamwork, develop a competitive spirit, increase motivation for
fitness development, improve physical fitness, help relieve stress, and add a
variety to Platoon programs. The overall goal of the Squad is to develop
future Army leaders who clearly provide purpose, direction, motivation, and
vision. Right now you are not showing motivation and this is prejudicial to
the interests of other Soldiers in the Platoon. PFC XXXXX you need to fix
this problem don't let it becomes a pattern of misconduct.
I am counseling you for the
conduct noted above. If this conduct
continues, action may be initiated to separate you from the Army IAW AR
635-200. If you are involuntary
separated, you could receive an Honorable Discharge, a General (Under
Honorable Conditions) Discharge, or Under Other Than Honorable Conditions
Discharge. An Honorable Discharge is a
separation with honor based on the quality of service, which meets the
standards of acceptable conduct and performance of duty. A General Discharge is a separation under
honorable conditions, based on a military record being satisfactory but not sufficiently
meritorious to warrant an Honorable Discharge. A discharge Under Other Than Honorable
Conditions is based upon a pattern of behavior of one or more acts or
omissions that constitutes a significant departure from the conduct expected
of a soldier. An Honorable Discharge
may be awarded under any provisions. A
General Discharge may be awarded for separation under Chapter 5, Chapter 9,
Chapter 13 and Chapter 14. An Under
Other Than Honorable Conditions Discharge may be awarded for separation under
Chapter 14 for misconduct. If you receive
an Honorable Discharge, you will be qualified for most benefits resulting
from military service. An involuntary
honorable Discharge, however, will disqualify you from reenlistment for some
period of time and may disqualify you from receiving transitional benefits
(e.g., commissary, housing, health benefits) and the Montgomery GI Bill if
you have not met other program requirements.
If you receive a General Discharge, you will be disqualified from
reenlisting in the service for some period of time and you will be ineligible
for some military and VA administered benefits, including the Montgomery GI
Bill. If you receive a discharge Under
Other Than Honorable Conditions, you will be ineligible for reenlistment and
for most benefits, including payments of accrued leave, transitional
benefits, the Montgomery GI Bill, and possibly transportation of dependents
and household goods to home. You may
also face difficulty in obtaining civilian employment as employers have a low
regard for General and Under Other Than Honorable conditions discharges. Although there are agencies to which you
may apply to have your characterization of service changed, it is unlikely
that such application will be successful. _______ (Soldier’s initials)
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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.
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DA FORM 4856,
AUG 2010
PREVIOUSE EDITIONS ARE OBSOLETE
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):
* You will read Army Regulation 350–1.
* You will tell me what this AR says
about motivation.
* You will also develop a plan to stay
motivated during Platoon PT and how you will motivate other Soldier's during
PT.
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  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):
o Ensures SM is counseled on expectations duty
performance for this month.
o Will tell SM where to find AR 350-1.
o Ensure we do a assessment after this is
complete.
Signature of Counselor: _________________________________________ Date:
_____________________
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Part IV - ASSESSMENT OF
THE PLAN OF ACTION
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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: __________
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Note: Both the counselor and the individual
counseled should retain a record of the counseling.
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DA FORM 4856,
AUG 2010
