DEVELOPMENTAL COUNSELING FORM For use of his form, soe ATP 6.22.1; the proponent agency is TRADOC. DATA REQUIRED BY THE PRIVACY ACT OF 1974 AUTHORITY: 5 USC 201, Departmental Regulations; 10 USC 3013, Secretary ofthe Army. PRINCIPAL PURPOSE: | To assist leaders in conducting and recording counseling data pertaining to subordinates. ROUTINE USES: The DoD Blanket Routine Uses set forth atthe beginning ofthe Army's compilation of systems or records notices also apply to tis system, DISCLOSURE: Disclosure is voluntary. PART - ADMINISTRATIVE DATA Name (ast Fist RankiGrade Date of Counaaing Doe, John M. E-1/Private 20220308, ‘Organization Name and Tile of Counsotor 1-112th CAV. E.CO, [SPC BOLTE, TREVION N/ TEAM LEADER PARTI BACKGROUND INFORMATION Purpose of Counseling: (Loador states the reason forthe counseling, e.g, PerformancerProfessional ar Event Orented counseling, and includes We Teader's facts and observations prior tothe counseling) Jail Counseling ‘The Purpote of this Counseling ito conduc intial ection & integration counseling. Ensure that ll immediate Soldinfamiyisue are resolved pomp, welome Soldier tothe unilcommunity and orient Soldier to andar, PART Il. SUMMARY OF COUNSELING Complete this section during or immediately subsoquont to counseling. Koy Points of Discussion: appearance and Uniform Policy. You need o make sure you ar inthe correct uniform forthe mission If you are unsure ofthe correct uniform, contact me and Iwill, provide you wit that infarmation. Maintain your unsforin accordance with AR 670-1, Identfaton badges will be wom in accordance wit eal policy, Take ide in your uniform. Bean exarple fr ocr Soldiers Army Values. Values ae the foundation forall we do. Layalty, Duty, Respect, Sells Servic, Honor, Ilerity and Personal Courage. They aes eating solders with digi and respect while not tolerating bigotry, sexual harassment, or fivorissm of any kind which svt othe succes of our unt and the Army Ode ethical behavior and moral conduct on and off duty must be above reproach and reflect these valves fob Performance. {wil counsel you on quarely basis «minimum, bu ore tan iksly monly oixform you ofthe reaghe and weaknests I observe in your performance Military Bearing and Professional Miltary Appeatance. Missin your militay bearing a all ines, Soldiers, pets and leaders are watching. As Sldir and asa junior leader, you must seta example, tay be tough a ines, but stay cla and focused onthe tion a hand Physical Fitness, Stay Stand ensere your peers doth sme. The Arm's minimum standard is to achieve 60 points in each ofthe three events (Pushap, Situp, To iter) fora ttl score of least I80 points, This she MINIMUM standard. Soldiers and leaders shoud strive to achieve a evel of ines that is gher than the imum standard Maitary Courtesy. You will ender appropriate courtesy to Senior Leaders, NCOs, Fellow Soldiers, patients, visitors and staat all times. You will lize appropriate ilar tiles wien sdtesing each ote, your Superior and ther military members impecable personal conducts expected a al times. When speaking to NCOs, you ned io bea the position of parade et unless od otherwise. Manin a good positive military bearing all ines to include on and of duty. Fou or obscene language, insubordination, discourtesy or oer inappropriate behavior wil rl in corectve disciplinary ation Timeliness an Tardnes.Tardiness wil be handled on cate by case bass, bat you wil be counssed appropriately. Make sire you ae present less 10 mines prior al anscunced formations [Commnicatin. As Soir, effstive communication is wery ers and wil ect our mission and even peoples lives, 1 expect you tobe upfront and ones. 1 eacourage yout uslize al eveaue of approaches and methods, such as email cell hoes and even text messaging to communicate with me, your NCOs and your Education. Set your goals achive them and make sre to say on rack all ines, Significant fe Events, such sa new baby, meting a significant special person ors health cri, an se you off ack Readnes. Readiness sa key issu that must always come fis. MEDPROS, Trinng, APT, Weapons Unifom, ec. Ensure tht you and your pets are prepared to oe inthe proper place, uniform and equipment if called pon for operations. Problems and Issues. expt you to come fo mean discus sues and problems you may bave. am svalable anytime to discus sus and problems you may have Responsibility and Accountability. Us proper crs, maintenance, banding and conservation of personel, equipment, supplies and poperty. Ensue the soto well stocked at al ines, Provide sate and healthful wok are for patients, staff and other soldier. Accept responsibilty for Your ova ations. ‘OTHER INSTRUCTIONS ‘This form wil be destroyed upon: reassignment (other than rehabiltatve transfers), separation at ETS, or upon rerement. Fr separation requirements and notification of oss of Benefis/consequences eae local crectives and AR 635-200 DAFORM 4656, JUL 2014 PREVIOUS EDITIONS ARE OBSOLETE: Page Tor?Plan of Action (Oulines aclons that the subordinale wil do afer the counsaling session fo reach the agroed upon goals) The actions must be Specific anough to madly or maintain tho subordinae's bohavir and include a spectied lime ine fr molementaion and assessment (Part IV bolow) o During tis counseling sesion we have discussed you duties, responsible, shot erm and long term gal, your expectations of meas a leader andthe basic standards you are expectod to maintain as «Soli and member ofthis team, o Short term goals: (3) Jo Long term goal: (3) Session Closing: (Te leader summarizes tho lay pots of th selon and cocks the subordinate understands the plan of elon. The subordinate sgroeudsagroct and provdes romans appropriate) Individual counseled: [_] | agree [_] esagre with the information above Individual counseled remarks Signature of Individual Counseled Date: Teader Responsibliies: (Leaders responsibilios In mploriening tre plan of action) Signature of Counselor Date: PART IV - ASSESSMENT OF THE PLAN OF ACTION ‘Rasesament: (Did tho plan of action achiove tho dosired rosulis? This socton is comploted by both the Toader and tho inudual counseled and provides useful information for follow-up counsolng) What you can expect fm me he following 01 wil ensure that you do the above tothe utmost of my ability 01 wil ensure Soir receives prope traning inal areas of jb performanc 01 wil provide you motivation, dzeeon, taining and environment to lear and sv. ms should aise isthe faa, | will asst yu in solving ther, Lam here to Belp you in any way possible fo ifany peo Individual Counsetod Date of asesement Counselor: : Both the counselor and the individual counseled should retain a record of the counseling. Pagetot? Note ‘DAFORM 4856, JUL 2078