DEVELOPMENTAL COUNSELING FORM
For use of this form see FM 22-100.
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
Jung, Chan-Hee
PV2 / E-2
KA 05-76055435
06 Oct 2005
Organization
Name and Title of Counselor
B Co. STB, 2D Infantry Division, APO AP 96258
SPC Chrysler / Team Chief
PART II – BACKGROUND INFORMATION
Purpose of Counseling: (Leader states the reason for the counseling, e.g. Performance/Professional or Event-Oriented
counseling and includes the leaders facts and observations prior to the counseling):
Initial Counseling to include:
1.
2.
3.
4.
5.
Performance
Appearance
Education
Physical Fitness
Military Courtesy
PART III – SUMMARY OF COUNSELING
Complete this section during or immediately subsequent to counseling.
Key Points of Discussion:
This is your initial counseling. This is an overview of what I expect from you and what you can expect from me.
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Performance- Ensure that you are always on time, do what you are told to do and perform all duties in a military
manner. Also, I expect you to become knowledgeable in your MOS and strive to attain the next level.
Appearance- Maintain your uniforms in accordance with AR 670-1 and 2D Infantry Division Regulation 600-5.
Your uniform identifies you as a member of the US Army and the 2D Infantry Division. Wear it with pride.
Abide by Army hair and fingernail standards and grooming policies. Your boots should be highly shined IAW
AR 670-1.
Education- I encourage you to take college classes and Army correspondence courses along with any available
military schooling. These will not only help you in your Army career, but also in your future should you decide
not to stay Army.
Physical Fitness- You need to ensure that you can pass a PT test at any time and also maintain the standards
governed by AR 600-9.
Military Courtesy- You need to show respect to your seniors, peers and subordinates alike. When speaking to
NCOs, you need to be at the position of parade rest. Maintain a good positive military bearing at all times to
include on and off duty.
What you can expect from me is the following:
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I will ensure that you do the above to the utmost of my ability.
I will provide you motivation, direction and training.
If any problems should arise in the future, I will assist you in solving them.
I am here to help you in anyway possible
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 635200
DA FORM 4856, JUN 1999
EDITION OF JUN 85 IS OBSOLETE
USAPA V1.00
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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 specific time line for
implementation and assessment (Part IV below):
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Soldier will hereby abide by the rules and regulations as outlined in this counseling.
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):
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I will ensure that the soldier understands and abides by the rules and regulations as outlined in this counseling.
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.
DA FORM 4856-E (Reverse)