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Download and make changes to Counseling for violation of Article 123a
(Issuing Worthless Checks) of the UCMJ. Requires Pure edge viewer
Article 123a Issuing Worthless Checks: Any member of the armed forces who, wrongfully writes a check with the intent to defraud, may be
punished under article 123a of the UCMJ.
                    DEVELOPMENTAL COUNSELING FORM
                                                   For use this form see FM 22-100
                                        DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY: 5 USC 301, Departmental Regulations; 10 USC 3013, Secretary of the Army and E.O. 9397 (SSN)
PRINCIPAL PURPOSE: To assist leaders in conducting and recording counseling data pertaining to subordinates
ROUTINE USES: For subordinate leader development IAW FM 22-100 leaders should use this form as necessary
DISCLOSURE: Disclosure is voluntary  
                                                        PART I - ADMINISTRATIVE DATA
Name (Last, First, MI)
Rank/Grade
Social Security No.
Date of Counseling
Organization
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)

Event-Oriented: Violation of article 123a (issuing worthless checks) of the Uniform Code Of Military Justice in that on or about(date) at
(location) you wrongfully issued a check with no funds to (What happened?)________________.
                                                    PART III - SUMMARY OF COUNSELING
                      Complete this section during or immediately subsequent to the counseling

Key Points of Discussion:
                                                       OTHER INSTRUCTIONS
This form will be destroyed upon reassignment (other than rehabilitative transfers), separations at ETS, or upon retirement. For separation requirements
and                                                                                       notification of loss of benefits/consequenses see local directives and AR 635-200
Initial Counseling                                                             Monthly Counseling

Over Weight Counseling                                                APFT  PT Test Failure

WLC Counseling                                                              Accessory after the fact

Conspiracy                                                                         Misuse of Government Credit Card

Fraudulent enlistment/separation                                 Absent without leave AWOL

Missing movement                                                           Bar To Reenlist

Disrespect toward a Officer                                           Civilian Education

Assaulting/disobeying an Officer                                   Debt Obligations

Disrespect toward an NCO/Warrant Officer               Motorcycle Safety

Lost/damaged military property                                     Pregnancy

Drunk on duty

Use/possession of a controlled substance

Malingering

Threats

Theft

Issuing worthless checks

Lost Military ID Card

Family Care Plan

Separation from the Military

Flag actions
Counseling Statement Examples