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PART II - BACKGROUND INFORMATION | |
Purpose of Counseling
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PART III - SUMMARY OF COUNSELING Complete this section during or immediately subsequent to counseling. | |
Key Points of Discussion:
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OTHER INSTRUCTIONS This form will be destroyed upon: reassignment (other than rehabilitative transfers), separation at ETS, or upon retirement. For separation requirements and notification of loss of benefits/consequences see local directives and AR 635-200. |
DA FORM 4856-E, JUN 99 EDITION OF JUN 85 IS OBSOLETE space |
Plan of Action:
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Session Closing: (The leader summarizes the key points of the session and checks to ensure the subordinate understands the plan of action. The subordinate agrees/disagrees and provides remarks if appropriate)
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Leader Responsibilities: : (Leader’s responsibilities in implementing the plan of action)
Signature of Counselor: ___________________ Date: ___4 June 2014__ | |
PART IV - ASSESSMENT OF THE PLAN OF ACTION | |
Assessment: (Did the plan of action achieve the desired results? This section is completed by both the leader and the individual counseled and provides useful information for follow-up counseling)
Counselor: _______________ Individual Counseled: ____________ Date of Assessment:__________ | |
Note: Both the counselor and the individual counseled should retain a record of the counseling. |
DA FORM 4856-E (Reverse) space |