Free army counseling form 13Free army counseling form 13
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DATE

RECORD OF ENLISTED COUNSELING
PRIVACY ACT STATEMENT
The authority for requesting the following information is contained in 5 U.S.C.
sec. 301, 10 U.S.C. 5947, 44 U.S.C. sec. 3101, and Executive Order No. 9397. This
information will be used to document quality force counseling actions not
prescribed in other directives. Department of the Navy personnel may also use the
information for evaluations and determinations in disciplinary, punitive and/or
administrative actions. Disclosure of this information is voluntary.
NAME (Last, First, Middle Initial)

GRADE

DIVISION/WORK CENTER/DUTY SECTION

NAME/GRADE OF COUNSELOR

SSN

REASON FOR COUNSELING
PERFORMANCE

RESPONSIBILITIES

OJT PROGRESS

CAREER ADVANCEMENT

SUPPORT OF DEPENDENTS

PRIVATE INDEBTEDNESS

SUBSTANDARD APPEARANCE

PERSONAL BEHAVIOR

OTHER (Specify)

REASONS WHICH CAUSED THE COUNSELING REQUIREMENT
(Give facts, details, sequence of events, specific dates, etc.)

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NAVPERS 1616/25 (5-90)

NSN 0106-LF-010-1000

PLAN (DEV