Initial Counseling1

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: 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

Organization Name and Title of Counselor
266 Military Police Company
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.
Spc. snuffy, this is your initial counseling statement. This counseling statement is to inform you of my expectations of you as a member of my
section. If you have any questions or comments, please feel free to address those to me, and I will work them out as needed.
PART III - SUMMARY OF COUNSELING

Complete this section during or immediately subsequent to counseling.
Key Points of Discussion:
Your areas of concern are:
1. Timeliness: Make sure you are at least 10 minutes prior to all announced formations.
2. Accountability: Be where you need to be, when you need to be there. In all events, you need to keep me, or in my absence one of the other
NCOs (SSG. Ferguson, SGT. Burcham, Spc. Strickler) aware of your whereabouts at all times.
3. Uniform: Your uniform needs to be pressed and presentable at all times. Your boots need to be highly shined at all times. At no time should
your uniform fall below the standards set forth in AR 670-1. Motor Pool duty and Field Exercises are not an excuse to wear a substandard
uniform. Also, you need to make sure you are in the correct uniform for the mission. If you are unsure of the correct uniform, contact me and I
will provide you with that information.
4. Duties: If you have duty, you need to ensure that you are in the proper place, at the proper time, and in the correct uniform for that duty. I will
inform you of any duties you may have as soon as I am made aware of them. Be aware that things change at a moment's notice, so be prepared in
case that situation arises.
5. Attitude: You need to have the proper military attitude at all times. Show the proper courtesy and respect to leaders, peers, and subordinates
alike. Always be professional and never allow your personal feelings to get in the way of respecting other Soldiers.
6. Appointments: If you have an appointment, let me know the time and purpose of the appointment as soon as possible. Preferably, directly
after you make the appointment. If you need to make an appointment, check with me before making the appointment so I can check the training
schedule. DO NOT make any appointments without checking with me first. This includes any appointments that your wife may need that will
cause you to stay at home to take care of your child.
7. Personal Issues: Any personal or family issues that arise, make sure to inform me so that I can give you whatever support you may need. Do
not be afraid to approach me with any concerns you may have, I cannot help a problem if I don't know the problem exists.
Other situations may arise that are not covered in this counseling session. If you are unsure about anything, contact me and I will work to
straighten out the situation. It is my duty as an NCO to help you develop into a better Soldier. However, I cannot do this alone. You must put
forth the effort to make yourself a better Soldier, and in return I will help guide you in the right direction for your military career.
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.
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 specified time line for implementation and assessment (Part IV
below).)
The following plan of action is to be considered:
During this session we have discussed your basic duties and responsibities and goals. During our next session we will discuss the progress
toward your goals. I would also like for you to take the time to look at the following areas and provide input.
-Determine what areas you would like to work on within Squad

-Training around the PTT mission for up coming deployment
- Becoming weapon matter experts on all assigned weapon systems in Squad
Long Term Goals:

1.
2.
3.
Short Trem Goals:

1.
2.
3.
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). I

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.
REVERSE, DA FORM 4856, JUN 1999 USAPA V1.00

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DEVELOPMENTAL COUNSELING FORM

DATA REQUIRED BY THE PRIVACY ACT OF 1974

PART III - SUMMARY OF COUNSELING

DA FORM 4856, JUN 1999 EDITION OF JUN 85 IS OBSOLETE USAPA V1.00

-Determine what areas you would like to work on within Squad

Long Term Goals:

Short Trem Goals:

Signature of Individual Counseled: Date:

Leader Responsibilities: (Leader's responsibilities in implementing the plan of action). I

Signature of Counselor: Date:

PART IV – ASSESSMENT OF THE PLAN OF ACTION

Counselor: Individual Counseled: Date of Assessment:

REVERSE, DA FORM 4856, JUN 1999 USAPA V1.00

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