DEVELOPMENTALCOUNSELINGFORM

Foruseofthisform,seeFM6-22;theproponentagency isTRADOC.

DATA REQUIRED BYTHE PRIVACY ACT OF 1974

AUTHORITY:5USC301,DepartmentalRegulations;10USC3013,Secretary oftheArmy.

PRINCIPALPURPOSE:Toassistleadersinconductingandrecordingcounselingdatapertainingtosubordinates.

ROUTINE USES:TheDoDBlanketRoutineUsessetforthatthebeginningoftheArmy'scompilationofsystemsorrecordsnoticesalso

apply tothissystem.

DISCLOSURE:Disclosureisvoluntary.

PARTI-ADMINISTRATIVEDATA

Name (Last,First,MI)Rank/GradeDateofCounseling

OrganizationNameandTitleofCounselor

PART II-BACKGROUND INFORMATION

PurposeofCounseling: (Leader statesthereasonforthecounseling,e.g.Performance/ProfessionalorEvent-Oriented counseling,andincludes

theleader'sfactsandobservationspriortothecounseling.)

PARTIII-SUMMARYOF COUNSELING

Completethissectionduringorimmediatelysubsequenttocounseling.

Key Points ofDiscussion:

OTHER INSTRUCTIONS

Thisformwillbedestroyedupon: reassignment (otherthanrehabilitativetransfers),separationatETS,oruponretirement. Forseparation

requirementsandnotificationoflossofbenefits/consequencesseelocaldirectivesandAR635-200.

DAFORM4856,AUG2010PREVIOUSEDITIONSAREOBSOLETE.APDPEv1.01ES

PlanofAction (Outlinesactionsthatthesubordinatewilldoafterthe counselingsessiontoreachtheagreedupongoal(s). Theactionsmustbe

specific enough:tomodifyormaintainthe subordinate'sbehavior andincludeaspecified timelineforimplementationand assessment(PartIVbelow)

Session Closing: (Theleadersummarizesthekeypointsofthesessionandchecksifthesubordinateunderstandstheplanofaction. The

subordinateagrees/disagreesandprovides remarksifappropriate.)

Individualcounseled:I agreedisagreewiththeinformationabove.
Individualcounseledremarks:

SignatureofIndividual Counseled:Date:

LeaderResponsibilities: (Leader'sresponsibilitiesinimplementingtheplan ofaction.)

Signature ofCounselor:Date:

PARTIV-ASSESSMENT OFTHEPLANOFACTION

Assessment: (Didtheplanofactionachievethedesiredresults? Thissectioniscompletedbyboththeleaderandtheindividualcounseled

and providesuseful informationforfollow-up counseling.)

Counselor:Individual Counseled:DateofAssessment:

Note: Boththecounselorandtheindividualcounseledshouldretainarecordofthecounseling.

REVERSE, DA FORM 4856,AUG 2010APDPEv1.01ES