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)
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)

Event-Oriented: Violation of article 83 (fraudulent enlistment, appointment, or separation) of the Uniform Code Of Military Justice in that on or
about (date) at (location) you did fraudulently (enlist or attempted to separate) from the United States Army.
                                                        PART III - SUMMARY OF COUNSELING
                         Complete this section during or immediately subsequent to the counseling

Key Points of Discussion:

Willingly providing false or incomplete information for the purpose of enlisting or separating from the armed forces is illegal
and grounds for separation under chapter 7, AR 635-200. If found guilty of this offense the maximum punishment
is______________________. As a member of the United States Military you are expected to uphold the Honor and
commitment of the Soldiers that have Honorably served our country before you. In committing such misconduct you have
brought discredit upon The United States Army, this Unit, and Yourself. Further misconduct of any type by you will not be
tolerated. (I am recommending that the commander impose nonjudicial punishment for your misconduct) OR (You will
receive corrective training as outlined in the plan of action).

You are here by notified that if this type of conduct continues, actions may be initiated under the Uniform Code of Military
Justice to separate you from the Army prior to your scheduled ETS Date IAW AR 635-200.  If you are involuntary
separated, you could receive an Honorable Discharge, a General (Under Honorable Conditions) Discharge, or a Under
Other Than Honorable Conditions Discharge. If you receive a discharge Under Other Than Honorable Conditions, you will
be ineligible for reenlistment and for most benefits, including payments of accrued leave, transitional benefits, the
Montgomery GI Bill, VA benefits, and You may also face difficulty in obtaining civilian employment.   
                                                                         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
Download and make changes to Counseling for violation of Article 83
(Fraudulent enlistment or separationj) of the UCMJ. Requires
Pure edge viewer
Article 83 Fraudulent enlistment, appointment, or separation: Any person who knowingly provides false information for enlistment or
appointment in the armed forces or deliberately conceals his/her qualifications and receives pay or allowances thereunder; or attempts to or
avoid separation from the armed forces by knowingly misrepresenting or deliberately concealing his/her eligibility for separation. will be
punished under article 83.
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




Issuing worthless checks

Lost Military ID Card

Family Care Plan

Separation from the Military

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Counseling Statement Examples
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