Dd Form 2648 - Preseparation Counseling Checklist For Active Component (Ac), Active Guard Reserve (Agr), Active Reserve (Ar), Full Time Support (Fts), And Reserve Program Administrator (Rpa) Service Members Page 4
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1
2
3
4
5NAME
SSN
(Last, First, Middle Initial)
PRESEPARATION COUNSELING
CHECKLIST FOR AC, AGR, AR,
FTS, AND RPA SERVICE
MEMBERS
SERVICE
SECTION IV (Continued)
SPOUSE
MEMBER
REFERRED TO
YES
NO
YES
NO
Reserve Transition Coordinator
18. RESERVE AFFILIATION
19. Do you want to attend the Veterans Benefits Briefing?
VA Representative
(See section III, Instructions, item 4.)
20. DISABLED VETERANS BENEFITS
VA Representative
a. Do you want to attend the Disabled Transition Assistance Program (DTAP)
Briefing?
See Section III - Instructions, item 5 and VA Vocational
Rehabilitation and Employment Service at
b. VA Disability Benefits
Provided link
Provided link
c. Benefits Delivery at Discharge and Quick Start
21. STATE VETERANS BENEFITS
VA Rep
22. 2-YEAR COMMISSARY AND EXCHANGE PRIVILEGES (Eligible Involuntary
Separatees)
23. LEGAL ASSISTANCE
Base Legal Office
24. POST GOVERNMENT (MILITARY) SERVICE EMPLOYMENT RESTRICTION COUNSELING
Information on post government (military) employment counseling (restrictions on employment, imposed by statute and regulation) shall
be conducted by Services as appropriate. Transition/Command Career Counselors shall refer separating and retiring Service members to
an installation legal office (Staff Judge Advocate or Counselor's Office) to ensure they receive a post government (military) employment
restrictions briefing or counseling from an ethics official.
25. INDIVIDUAL TRANSITION PLAN (ITP)
a. As a separating Service member, after receiving Preseparation Counseling information and completing this checklist, you and your spouse/
family member/legal guardian/designee (if applicable) are entitled to receive assistance in developing an Individual Transition Plan (ITP) based
on the areas of interest you have identified on this checklist. The Preseparation Counseling Checklist addresses a variety of transition
services and benefits to which you may be entitled. Each individual is strongly encouraged to take advantage of the opportunity to develop
an ITP. The purpose of the ITP is to identify educational, training, and employment objectives and to develop a plan to help you achieve these
objectives. It is the Military Department's responsibility to offer Service members the opportunity and assistance they need to develop an ITP.
It is the Service member's responsibility to develop an ITP based on his/her specific objectives and the objectives of his or her spouse, if
appropriate.
SERVICE
SPOUSE
Based upon information received during Preseparation Counseling, do you and/or your spouse/family member/
MEMBER
legal guardian/designee desire assistance in developing your ITP? If YES, the Transition staff/counselor/
YES
NO
YES
NO
Command Career Counselor is available to assist you (see website).
b. To assist your transition counselor, choose the answer that best describes your post-military goal(s): (X all that apply)
I already have post-military employment.
I plan to go to school and use my VA education benefits.
I plan to get a job and start work as soon as possible.
I don't know what I plan to do.
Other (please describe/write in)
SECTION V - LANGUAGE SKILLS/REGIONAL EXPERTISE
Counselors will ensure all transitioning Service members, Active, Guard and Reserve with language skills and/or regional expertise complete
Item 26.
26. The Department of Defense and other Federal agencies have placed a high level of importance on critical foreign language skills and regional
expertise to meet emerging requirements during times of need, crisis, and/or national emergency. The Department of Defense and other
Federal agencies may want to contact you in the future to determine if you would be willing to volunteer your services or to offer you
potential employment that would take advantage of your language proficiency and/or regional expertise.
a. Do you consent to being contacted by the Department of Defense for such purposes?
YES
NO
b. Do you consent to having the Department of Defense share your information with other Federal agencies for
YES
NO
such purposes?
DD FORM 2648 TEST, JAN 2011
Page 4 of 5 Pages
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