For use of this form, see FM 22-102; the proponent agency is TRADOC

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 whiners in documenting hurt feelings, and to provide leaders with a list of soldiers who require additional counseling, NCO
leadership, and extra duty..
ROUTINE USES: For subordinate leader development IAW FM 22-102. Leaders & whiners should use this form as necessary.
DISCLOSURE: Disclosure is voluntary, but repeated disclosure may result in a DA Form 779-1A, Report of Wall To Wall Counseling

David Ticknor WO1 123456789 May 18th 2018

7th Cavalry Gaming Warrant Officer 1, David Ticknor. B/2/A/1-7 ASL

May 18th 2018 Like 11 Pm Team Speak 3 Warrant Officer 2, Jordan.T

Mitsuma.R 1st Lt.

3x
At approximately 23:35:18 Central Time, First Lieutenant Mitsuma joined the Bravo section Teamspeak Channel of
Second Platoon, Alpha company. He partook in small talk with myself, WO1. Ticknor, CPL. Lee.RA, CPL. Wright.P, and
Second Lieutenant Ratcliff. This small talk mainly consisted of topics ranging from personal needs, to getting got. It was
at this time Lee brought up when Mitsuma will become nicer. At this time he [Mitsuma] took me, unwillingly, up to the
Alpha Company Private Office Channel. He made many false promises, and attempted to tell me he would even double
my pay! While technically correct, it remined me that 0 time 2 is still 0, which made me sad ☹. Afterwords, we went
back to our previous channel. He then became unresponsive, and acted like nothing happened. He claims “his wife got
home”, which we all know, Mitsuma couldn’t attract a wife. He then said I need to impress a certain individual, but I can
only assume he meant to say that I will never be able to impress him. This was a direct assault to my self esteem and
ego. This is the issue at hand!

David Ticknor David Ticknor