DEVELOPMENTAL COUNSELING FORM
For use of this form, see ATP 6-22.1; the proponent agency is TRADOC.
AUTHORITY:
PRINCIPAL
PURPOSE:
NOTE:
PRIVACY ACT STATEMENT
5 USC 301, Departmental Regulations, 10 USC 3013, Secretary of the Army.
These records are created and maintained to manage the member's Army and Army National Guard service effectively, to document historically a member's
military service,and safeguard the rights of the member and the Army.
For additional information, see the System of Records Notice A0600-8-104b AHRC, https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/
Article/570051/a0600-8-104b-ahrc/.
ROUTINE USE(S): There are no specific routine uses anticipated for this form; however, it may be subject to a number of proper and necessary routine uses identified in the system of
records notice specified in the purpose statement above.
DISCLOSURE:
Disclosure is voluntary.
PART I - ADMINISTRATIVE DATA
Rank/Grade
Name (Last, First, MI)
SYLVA, SHARHAN, A
Date of Counseling
E-4
Organization
01-Oct-2023
Name and Title of Counselor
1/297 INF BISON CO
SGT SARMIENTO
PART II - BACKGROUND INFORMATION
Purpose of Counseling: (Leader states the reason for the counseling, e.g. Performance/Professional/Event-Oriented counseling, and include the leader's facts
and observations prior to the counseling.)
Approach:
✔ Non Directive
Type of Counseling:
Combined
✔ General Form
Directive
Professional Growth
Performance
Event Oriented
Initial Counseling
PART III - SUMMARY OF COUNSELING
Complete this section during or immediately subsequent to counseling.
Key Points Discussion:
1. Timeliness: Make sure you are at least 15 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 (SGT Braendel, Nuanphong, Thompson, and Williams) aware of your whereabouts at all times.
3. Uniform: Your uniform needs to be clean and presentable at all times. Your boots need clean and free from dirt, mud, cuts and tears. 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: Conduct yourself in a professional manner towards all NCOs and Officers in the unit. Assume the position of attention when
speaking to an officer and the position of parade rest when addressing an NCO. 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.
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.
8. Physical fitness: Participate in PT every morning unless otherwise instructed by me or other supervisors in the chain of command. Fitness
is the foundation of Soldering; make it a priority. Be prepared to pass an ACFT at any moment ATP 7-22.01, Ch. 2-31 states, "...Soldiers
must attain a score of at least 60 points on each event and an overall score of at least 360 points". If you fail to pass an ACFT you may be
flagged and have all favorable actions suspended. Per Army Directive 2022-05.
9.Bison Co Holistic Health and Fitness: You will read the memo, understand the memo, and incorporate the memo into your partake of this
memo.
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, MAR 2023
PREVIOUS EDITIONS ARE OBSOLETE.
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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).
Ensure you are at the proper place at the proper time and in the proper uniform.
Follow the guidelines presented in this counseling.
Ensure you are following the standards set forth by this section, this company, and all ARs.
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 (YYYMMDD):
SYLVA.SHARHAN.ASHATI.1572446413
Digitally signed by SYLVA.SHARHAN.ASHATI.1572446413
Date: 2023.11.04 20:34:56 -06'00'
20231104
Leader Responsibilities: (Leader's responsibilities in implementing the plan of action.)
To help ensure you are keeping within the standards.
To provide you with whatever means necessary to accomplish your mission.
To guide you in the right direction to further your military career.
Signature of Counselor:
Date (YYYYMMDD):
SARMIENTO.GEORGE.RODRIGUEZ.1455348028
Digitally signed by SARMIENTO.GEORGE.RODRIGUEZ.1455348028
Date: 2023.11.04 20:35:30 -06'00'
20231104
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.)
SIGNATURES
Counselor:
Individual Counseled:
Date of Assessment (YYYYMMDD):
Note: Both the counselor and the individual counseled should retain a record of the counseling.
DA FORM 4856, MAR 2023
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