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The Developmental Counseling Form begins with a section which contains the items of Authority, Principal Purpose, Routine Uses, and Disclosure, and gives a brief introduction of this form. As for the main body of this template, there are four parts, namely, Administrative Data, Background Information, Summary of Counseling, and Assessment of the Plan of Action. This template is pretty practical, and you can download it for your reference for free.

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Name
(Last, First, MI)
Rank/Grade Date of Counseling
Organization Name and Title of Counselor
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.)
Key Points of Discussion:
DEVELOPMENTAL COUNSELING FORM
For use of this form, see FM 6-22; the proponent agency is TRADOC.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY:
PRINCIPAL PURPOSE:
ROUTINE USES:
DISCLOSURE:
5 USC 301, Departmental Regulations; 10 USC 3013, Secretary of the Army.
To assist leaders in conducting and recording counseling data pertaining to subordinates.
The DoD Blanket Routine Uses set forth at the beginning of the Army's compilation of systems or records notices also
apply to this system.
Disclosure is voluntary.
PART I - ADMINISTRATIVE DATA
PART II - BACKGROUND INFORMATION
PART III - SUMMARY OF COUNSELING
Complete this section during or immediately subsequent to counseling.
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.
PREVIOUS EDITIONS ARE OBSOLETE.
DA FORM 4856, AUG 2010
A
PD PE v1.01ES
DA Form 4856
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