Free army counseling form 15Free army counseling form 15
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EVALUATION REPORT & COUNSELING RECORD (E1 - E6)
1. Name
5.

ACT

(Last, First MI Suffix)
FTS

Occasion for Report
10. Periodic
16. Not Observed
Report

INACT

2. Rate
AT/ADSW/265

Detachment
11. of Individual
Type of Report
17. Regular

22. Reporting Senior (Last, FI MI)

6. UIC

3. Desig

7. Ship/Station

Promotion /
12. Frocking

4. SSN
8. Promotion Status

13. Special

Clear Form

RCS BUPERS 1610-1

Period of Report
14. From:
20. Physical Readiness

9. Date Reported

15.To:
21. Billet Subcategory (if any)

18. Concurrent
23. Grade

24. Desig

25. Title

26. UIC

27. SSN

28. Command employment and command achievements

29. Primary/Collateral/Watchstanding duties. (Enter Primary duty abbreviation in box.)

For Mid-term Counseling Use. (When completing EVAL
Enter 30 and 31 from counseling worksheet sign 32.)

30. Date Counseled

31. Counselor

32. Signature of Individual Counseled

PERFORMANCE TRAITS: 1.0 – Below standards / not progressing or UNSAT in any one standard; 2.0