Unsatisfactory Participation Checklist - Officer
SOLDIER NAME/RANK:___________________________________________SSN:_______-______-________
UNIT:________________________________________UIC___________________________________________
UNIT POC NAME/PHONE NUMBER:__________________________________________________________
INTERMEDIATE REVIEW (Brigade) _____________________________________________________________
REVIEWER (Name/Date):_______________________________________________________________________
The following documents must be attached:
1._____Copy of this checklist
2. ____ DA 4651-R
3._____Copies of "U" letters.
________
(if undeliverable - copy of mailed envelope) (date)
________
(if undeliverable - copy of mailed envelope) (date)
________
(if undeliverable - copy of mailed envelope) (date)
4._____DA Form 4856 (Developmental Counseling Form), completed by First Line Leader
5._____DA Form 4856 (Developmental Counseling Form), completed by Commander
6._____DA Form 4856 (Developmental Counseling Form), completed by the Retention/Transition
NCO, documenting attempts to recover the soldier
7._____PQR. (2B)
9. _____ Officer Elections of Options
MSC___________________________________________
MSC POC NAME/PHONE NUMBER____________________________________________________________
MSC REVIEW (DATE/SIGNATURE)____________________________________________________________
Date 1st Letter Mailed (Certified w/affidavit of service)
Date 2nd Letter Mailed (Certified w/affidavit of service)
Date 3rd Letter Mailed (Certified w/affidavit of service)
8. ______Notification (MG Evans) on Involuntary Separation (Certified w/affidavit of service)
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