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WHOLESOLDIER COUNSELING FORM

DATA REQUIRED BY THE PRIVACY ACT OF 1974

Type of Counseling: Performance

PRINCIPAL PURPOSE & USE: Soldier Counseling

AUTHORITY: 5 USC 301, 10 USC 3013, AR 623-3
DISCLOSURE: Voluntary

PART I - ADMIN
a1. SOLDIER NAME (Last, First, Middle Initial )
b1. UIC
b2. PLT/SEC

a2. RANK
b3. BASD

a3. MOS
b4. DOR

a4. DoD ID #
b5. ETS

c1. ASSESSOR NAME (Last, First, Middle Initial ) c2. RANK

c3. MOS

c4. DoD ID #

HQ

Frequency
Impact
Category

CHARACTER
Honor, Integrity, Candor,

b8. THRU DATE

c5. EMAIL (.gov or .mil)

NEGATIVE
CLEAR TARGET

a5. EMAIL (.gov or .mil)
b6. RCP
b7. FROM DATE

Always
Unacceptable
Separate

Nearly Always
Very Bad
Problem

PART II - ASSESSMENT

POSITIVE

NEUTRAL
Usually
Bad
Needs Work

Mixed
Marginal
Minimum Standard

Looks for loopholes and lacks the integrity to be trusted. Won't take a stand for
what is right. Tells half-truths under pressure.

Usually
Good
Over Standard

Nearly Always
Very Good
Strong Performer

Always
Excellent
O