Counter
             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 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 DA Form 4856 Counseling for violation of Article 83
(Fraudulent enlistment or separationj) of the UCMJ. Requires Pure edge viewer
Army Counseling, 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.
THIS IS NOT A GOVERNMENT SPONSORED WEB SITE
Sergeant's Time Training, enlisted fraud
Sergeant's
Time
Training.Com
AKO
Custom Search
Home>>> Counseling Examples>> Enlistment Fraud or Separation

This free script provided by
JavaScript Kit

Download 1 PowerPoint Show with over 20 PowerPoint
Classes. No more digging through all of your files
and folders to find a class, the main page has a
Menu for easy access to all of your PPT Classes all
are just a click away. Safe and easy to download Via
link, Try it Today!