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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 108 (loss or damage of military property) PVT Balls Lost his/her Military identification card on 31 March 2007.
(what happened? where was it lost? explain in detail)  
                                            PART III - SUMMARY OF COUNSELING
               Complete this section during or immediately subsequent to the counseling

Key Points of Discussion:

PVT Balls, On 31 March 2007, you lost your Military Identification Card. Your Military Identification Card is government
property. It is your responsibility to maintain your military identification card on your person at all times and report its loss
or theft to the proper authorities immediately. Your negligent behavior has jeopardized the security of our military
installation as well as the security of military installations around the world. You are required to report  the loss of your
Identification Card to the Provost Marshall and the ID card section of the PSB to have another Military Identification Card
re-issued immediately.



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 Lost Military ID Card
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Article 108 Loss, damage, or selling of military property: Any member of the armed forces who,  without proper authority; (1) sells or otherwise
disposes of: (2) willfully or through neglect damages, destroys, sells, or loses military property;  may be punished under article 108.
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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

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Counseling Statement Examples
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