Fillable DEVELOPMENTAL COUNSELING FORM

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DEVELOPMENTAL COUNSELING FORM

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Name
(Last, First, MI)
Rank/Grade Date of Counseling
Organization Name and Title of Counselor
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.)
Key Points of Discussion:
DEVELOPMENTAL COUNSELING FORM
For use of this form, see ATP 6-22.1; 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.
To assist leaders in conducting and recording counseling data pertaining to subordinates.
The DoD Blanket Routine Uses set forth at the beginning of the Army's compilation of systems or records notices also
apply to this system.
Disclosure is voluntary.
PART I - ADMINISTRATIVE DATA
PART II - BACKGROUND INFORMATION
PART III - SUMMARY OF COUNSELING
Complete this section during or immediately subsequent to counseling.
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.
PREVIOUS EDITIONS ARE OBSOLETE.
DA FORM 4856, JUL 2014
APD LC v1.03ES
Page 1 of 2
Months from ETS: Creditable Years of Service for Retirement:
ETS Date: PEBD: Previous Extensions:
Flagged: DMOSQ: Excess:
Are you currently drawing Incentives from any previous extension or enlistment?
(AB) (EB) (REB) (SLRP)
Are you currently utilizing education benefits? (FTA) (STAP) (MGIB) (MGIBK)
Eligible for Reenlistment Incentive (Bonus, SLRP, MGIB - Kicker):
Montgomery GI Bill Benefits:
MGIB 1606
MGIB 1607
MGIB 30
MGIB CH 33 (Transferability)
Discuss features of membership in the MIARNG:
Tricare Reserve Select
TSP
VA Home Loan
Drill Pay
Skills Training
Education Benefits (DANTES/CLEP, Scholarships, Grants, Joint Service Transcripts)
Retirement Benefits
Tricare for Life
Discounted Travel
Discuss factors affecting decision to extend/ETS:
Unit leadership
OPTEMPO
Training
Camaraderie and Esprit De Corps
Home life and Family influence
Civilian and Career Requirements/conflicts
Discuss Military Career Progression:
What are your current goals in the military?
Leadership opportunities (EPS, Change MOS, Statewide Vacancies, OCS, WOCS)
Service School Availability/Requirements (NCOES, SSD, MOSQ, ASI/SQI)
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)
Individual counseled remarks:
Leader Responsibilities:
(Leader's responsibilities in implementing 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.)
REVERSE, DA FORM 4856, JUL 2014
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.
Signature of Individual Counseled: Date:
Signature of Counselor: Date:
PART IV - ASSESSMENT OF THE PLAN OF ACTION
Individual Counseled: Date of Assessment:Counselor:
Note: Both the counselor and the individual counseled should retain a record of the counseling.
APD LC v1.03ES
Page 2 of 2
Soldier will extend current enlistment for ____________ years for the following benefits:
Soldier will ETS for the following reasons:
Maintain a copy of this counseling for a period of 1 year.
Ensure full-time unit staff/retention NCO are informed of Soldier's decision
Follow up to ensure proper documentation is prepared and distributed in a timely manner.
Notify unit leadership of positive and negative factors influencing Soldier's decision to extend or ETS.
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DEVELOPMENTAL COUNSELING FORM

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Completed 4 November 2020

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