
AR 623-3
NCOER COUNSELING AND SUPPORT FORM
PART I - ADMINISTRATIVE DATA
b. SSN c. RANK a. NAME(Last, First, Middle Initial) d. DATE OF RANK e. PMOSC
PART II - AUTHENTICATION
a. NAME OF RATER (Last, First, Middle Initial)
(Last, First, Middle Initial)
SSN
RANK, PMOSC/BRANCH, ORGANIZATION, DUTY ASSIGNMENT RATER'S AKO EMAIL ADDRESS
b. NAME OF SENIOR RATER SSN
INITIAL LATER LATER LATER
SENIOR RATER'S AKO EMAIL ADDRESS
LATER LATER LATER INITIAL
PD PE v1.00ES
PREVIOUS EDITIONS ARE OBSOLETE.
DA FORM 2166-8-1, OCT 2011
RANK, PMOSC/BRANCH, ORGANIZATION, DUTY ASSIGNMENT
f. UNIT, ORG., STATION, ZIP CODE OR APO, MAJOR COMMAND
Page 1 of 2
(.gov. or .mil)
(.gov. or .mil)
STATUS CODE
FOR OFFICIAL USE ONLY (FOUO)
SEE PRIVACY ACT STATEMENT
IN AR 623-3.
l. RATED NCO'S EMAIL ADDRESS
(.gov or .mil)
m. UIC n. CMD
CODE
o. PSB
CODE
PERFORMANCE SUMMARY:TASK/ACTIONS:
RANK, PMOSC/BRANCH, ORGANIZATION, DUTY ASSIGNMENT REVIEWER'S AKO EMAIL ADDRESS
(.gov. or .mil)
c. DAILY DUTIES AND SCOPE (To include, as appropriate, people, equipment, facilities and dollars)
d. AREAS OF SPECIAL EMPHASIS
e. APPOINTED DUTIES
INITIAL
INITIAL
a. PRINCIPAL DUTY TITLE
c. NAME OF REVIEWER(Last, First, Middle Initial) SSN
LATER LATER LATER
d. RATED NCO's INITIAL's
LATER LATER LATER
PART III - DUTY DESCRIPTION
(Rater)
b. DUTY MOSC
PART IV - ARMY VALUES/ATTRIBUTES/SKILLS/ACTIONS
(Rater)
f. PHYSICAL FITNESS & MILITARY BEARING
HEIGHT/WEIGHT APFT APFT DATE
a. ARMY VALUES:
LOYALTY, DUTY, RESPECT/EO/EEO, SELFLESS-SERVICE, HONOR, INTEGRITY, PERSONAL
For use of this form, see ; the proponent agency is DCS, G-1.