Developmental Counseling FORM For use this form, see FM 6-22; the proponent agency in 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: The DoD Blanket Routine Uses set forth at the beginning of the Army’s compilation of systems or records also                                  apply to this system DISCLOSURE:  Disclosure is voluntary.
Part I - Administrative Data
Name (Last, First, MI)		Rank/Grade	Date of Counseling
Organization	Name and Title of Counselor
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 leader’s facts and observations prior to the counseling):               Provide guidance for your school
Part III - Summary of Counseling Complete this section during or immediately subsequent to counseling.
Key Points of Discussion
You are scheduled to attend school at ___________on ______________.   If there is something that prevents you from attending this course, such as, medical reason, Family conflict, you must present documentation and notification immediately to your chain of command.   Ensure that you have an approved DTS authorization for your travel to school. If you do not know how to do this on your own, coordinate with the training NCO.   Ensure that you have the correct number of orders prior to leaving for school. Some school require as many as ten sets of orders, have these in a safe place.   Ensure that you sit with either the training NCO or myself and complete a pre-execution checklist. Make three copies and keep it in a safe place.   Ensure that you are in compliance with AR 600-9. You will be weighed and taped prior to leaving for school.   Ensure that you have taken and passed an APFT within 30 days of school attendance, this is an Army Policy! Complete your DTS for your travel pay. Ensure that you pay your government travel card bill first!   Your course Scope, Prerequisite, and School information is located in the ATRRS Course Catalog.   While you are in school, conduct yourself in a professional manner. Do not act in any way, which will bring discredit to yourself, your family or your unit. If you encounter a problem while you are at school, notify your school chain of command immediately, IAW their guidelines. Once time permits, notify our chain of command at the Company / Battery. Bad news does not getter better with time. Keep open lines of communication with the chin of command at home so we may track your progress through school.      Take good notes! We are sending you to this school to become a force multiplier. Bring back what you have learned and share it with others in your Team/Squad/Platoon and peer group.   Lastly, we expect that you will graduate from this course. When you do graduate, make copies of your course completion certificates and DA 1059 and bring them to me, so we could put in your packet. Make copies of your documents for yourself and keep them in a safe place. If you have the ability, scan these documents and store them digitally.
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, AUG 2010                            PREVIOUSE 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 specific time line for implementation and assessment (Part IV below):  Check your personal equipment for packing list deficiencies.     Get all copies of your documents.     Complete DTS authorization.     Execute an APFT and complete a height and weight assessment.     Satisfy all medical requirements before leaving / make sure MEDPROS is updated     Ensure you and your family have a plan in place for any emergencies that may arise while you are away from home.      Maintain open lines of communication with the chain of command while you are gone.

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): •  Provide outstanding guidance and mentorship 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, AUG 2010

For the first time, we are asking you, our patrons, to donate what you can if you find this   

                            site useful. Even a dollar or two will help. Thanks!