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DEVELOPMENTAL COUNSELING FORM

For use of this form see FM 22-100; 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 and E.O. 9397 (SSN)
To assist leaders in conducting and recording counseling data pertaining to subordinates.
For subordinate leader development IAW FM 22-100. Leaders should use this form as necessary.
Disclosure is voluntary.

PART I - ADMINISTRATIVE DATA
Rank / Grade
Social Security No.
Date of Counseling


Name and Title of Counselor

PART II - BACKGROUND INFORMATION
Purpose of Counseling: (Leader states the reason for the counseling, e.g. Performance/Professional or Event-Oriented counseling and
includes the leaders facts and observations prior to the counseling):
Name (Last, First, MI)

Organization

1. INITIAL (

)

2. SEMI-ANNUAL/PERFORMANCE (
3. EVENT (

)

)

4. MID-YEAR/DRAFT (

)

PAR