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)
Ball, John, W
Social Security No.
Date of Counseling
10 January 2010
678th Aviation Company
Name and Title of Counselor
Audie Murphy, SSG, USA, Squad leader
                                               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)

Promotion/developmental Counseling:

Review SPC Ball's substandard skills, knowledge, and competency over the past 90 days
Inform SPC Balls that he will not be recommended for promotion for the month of January
                                                  PART III - SUMMARY OF COUNSELING
                        Complete this section during or immediately subsequent to the counseling

Key Points of Discussion:
SPC Ball's your performance over the last 90 days has been substandard and does not show signs of improvement,
therefore you will not be recommended for promotion based on these facts. You will have many opportunities to show
improvement and leadership abilities before your next evaluation. You have the potential to be great Soldier; don't mess it
up and get on the right track.  

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 Promotion Counseling Statement for Soldiers not recommended
False statements of the UCMJ. Requires Pure edge viewer
Promotion Counseling Statement Not Recommended: Use this counseling statement to inform the Soldier why he/she is not being
recommended for promotion to the next grade. Soldiers must be counseled when they become eligible for promotion, every 90 days or as
deemed necessary by the supervisor.
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

Flag actions
Counseling Statement Examples
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