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                         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 89 (disrespect toward a superior Commissioned Officer) of the Uniform Code Of Military Justice in that on or
about (date) at (location) you were disrespectful to (name) your superior Commissioned Officer. (state in detail what happened).
                                                             PART III - SUMMARY OF COUNSELING
                               Complete this section during or immediately subsequent to the counseling

Key Points of Discussion:

Disrespect towards superior Commissioned Officers is unacceptable behavior and will not be tolerated. If found guilty of
this offense, the maximum punishment is ______________________. Your disrespect has been detrimental to unit morale
and the discipline of this organization and should not be repeated. (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 89
(Disrespect toward a superior Commissioned Officer) of the UCMJ. Requires Pure edge viewer
Article 89 Disrespect toward a superior Commissioned Officer: Any member of the armed forces who behaves with disrespect toward a
superior Commissioned Officer, may be punished under article 89.
THIS IS NOT A GOVERNMENT SPONSORED WEB SITE
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
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