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Get 104 R Form in PDF

The 104 R form, known as the Planned Academic Program Worksheet, is essential for students in the Army Senior ROTC program. This form helps to outline the academic plan necessary for students to meet their degree requirements while ensuring compliance with public law and Army regulations. Completing the 104 R form is a crucial step for those seeking commissioning in the Army.

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What to Know About This Form

  1. What is the purpose of the 104 R form?

    The 104 R form, also known as the Planned Academic Program Worksheet, is primarily designed to gather essential information for managing the Army Senior ROTC program. It helps in assessing whether students meet the academic requirements necessary for commissioning into the Army. The form collects data about the student’s academic major, credit hours, GPA, and course details to ensure compliance with public law and Army regulations.

  2. Who needs to fill out the 104 R form?

    This form is required for students enrolled in the Army ROTC program. Specifically, it is intended for cadets who are planning their academic programs and need to demonstrate that they can complete their degree requirements within the stipulated time frame. Cadets must provide accurate and comprehensive information about their academic progress and future coursework.

  3. What information is required on the 104 R form?

    When completing the 104 R form, students must provide various details, including:

    • Name and academic major
    • CIP code
    • Date of form preparation
    • Academic school and credit hours
    • Grade point average (GPA) details
    • Course information, including term, year, course number, title, credit hours, and grades
    • Signatures from both the student and the registrar or certifying official

    This information is crucial for evaluating the cadet’s academic standing and progress toward their degree.

  4. How does the 104 R form impact a cadet's ROTC scholarship?

    For cadets participating in the ROTC scholarship program, the 104 R form plays a significant role in maintaining their scholarship eligibility. The form outlines the remaining credit hours needed for degree completion and confirms that the cadet is on track to fulfill the requirements. If the academic plan is approved, the scholarship will remain in force for the specified number of semesters, ensuring financial support for the cadet's education.

  5. What happens if a cadet does not provide accurate information on the 104 R form?

    Providing inaccurate information on the 104 R form can lead to serious consequences for a cadet. It may affect their eligibility for the ROTC program, scholarship funding, and ultimately their commissioning in the Army. It is crucial for cadets to ensure that all details are correct and up to date. If there are discrepancies, it is advisable to address them promptly with the appropriate academic or ROTC advisors.

Misconceptions

  • Misconception 1: The 104 R form is only for students who are already enrolled in ROTC.
  • This is inaccurate. The form serves as a planning tool for both current and prospective students. It helps in assessing eligibility and academic progression for those interested in joining the Army ROTC program.

  • Misconception 2: Completing the 104 R form guarantees a scholarship.
  • While the form is a critical component of the application process, it does not automatically secure a scholarship. Scholarship decisions are based on a variety of factors, including academic performance and leadership potential.

  • Misconception 3: The information on the 104 R form is not confidential.
  • In fact, the form contains sensitive personal data. The Privacy Act of 1974 protects this information, ensuring it is used solely for the administration of the ROTC program.

  • Misconception 4: The 104 R form only needs to be filled out once during a student's academic career.
  • This is misleading. Students must update the form regularly to reflect changes in their academic plans, course enrollments, or degree requirements. Continuous monitoring is essential for maintaining eligibility.

  • Misconception 5: The 104 R form is irrelevant for students attending community colleges.
  • This is incorrect. Community college students can also participate in the ROTC program and must complete the 104 R form to outline their academic plans and ensure they meet the necessary requirements.

  • Misconception 6: Only certain majors can utilize the 104 R form.
  • All academic majors can use the form. It is designed to accommodate various fields of study, ensuring that students from diverse backgrounds can plan their academic paths effectively.

  • Misconception 7: The 104 R form is solely for academic purposes.
  • While it primarily focuses on academic planning, the form also plays a role in assessing a student’s commitment to the Army ROTC program. It is a comprehensive tool that supports both educational and military objectives.

Form Breakdown

Fact Name Details
Authority This form is governed by Title 10, U.S. Code Sections 2101 and 2104.
Principal Purpose The form collects necessary information for managing the Army Senior ROTC program and ensuring compliance with public law.
Routine Use It helps in projecting an academic plan to confirm if the applicant meets the requirements for the remaining academic years.
Voluntary Disclosure Providing information is voluntary, but it is essential for determining eligibility for the Army ROTC program.
Data Required Key information such as the student’s name, academic major, credit hours, and GPA are required for completion.
Signature Requirement The form requires signatures from both the student and the registrar to validate the academic plan.

Common mistakes

  1. Incomplete Information: Failing to fill out all required fields can lead to delays. Each section of the form is important for evaluating eligibility.

  2. Incorrect Dates: Entering the wrong date format can cause confusion. Use the MM/DD/YYYY format as specified in the instructions.

  3. Missing Signatures: Not signing the form can result in rejection. Ensure both the student and the certifying official sign and date the document.

  4. Incorrect Course Information: Listing courses inaccurately can affect academic progress assessments. Double-check course numbers, titles, and credits.

  5. Ignoring the Review Section: Failing to confirm that all courses are required for degree completion may lead to misunderstandings. Always indicate whether the listed courses fulfill degree requirements.

Preview - 104 R Form

PLANNED ACADEMIC PROGRAM WORKSHEET

For use of this form, see USACC Pam 145-4, the proponent agency is ATCC-PA-C

DATA REQUIRED BY PRIVACY ACT STATEMENT OF 1974

1.AUTHORITY: Title 10, US Code 2101 and 2104

2.PRINCIPAL PURPOSE(S): To provide information and data necessary for administering the Army Senior ROTC program, processing, and managing of selected students for commissioning in the Army IAW established public law and Army Regulations.

3.ROUTINE USE(S): To provide a projected academic plan to determine if the applicant meets the public law requirements of two remaining academic years.

4.VOLUNTARY DISCLOSURE AND EFFECT ON INDIVIDUAL NOT PROVIDING INFORMATION: Voluntary information is necessary to determine eligibility of the individual for acceptance,

continuance, or discontinuance in the Army ROTC program.

 

1. NAME OF STUDENT (LAST, FIRST, MI)

 

 

 

2. ACADEMIC MAJOR

 

 

2a. CIP CODE

3. AS OF DATE (MM/DD/YYYY) (Date of form preparation)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. ACADEMIC SCHOOL

 

 

 

 

 

5. CREDIT HOURS

 

 

 

 

 

6. GRADE POINT AVERAGE (GPA)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Select Semester or Quarter (S/Q)

Semester

 

 

 

Term:

 

 

 

 

 

 

 

 

 

Term:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a. IDENTIFICATION (Check one):

Host

 

 

 

 

 

 

 

 

 

Curr GPA:

 

 

 

CUM:

 

 

Curr GPA:

 

 

CGPA:

 

 

 

 

 

Extension Center

 

 

 

a. Total required for degree:

 

 

1

 

 

Term:

 

 

 

 

 

 

 

 

 

Term:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cross-Enrolled

 

 

 

(1) ROTC Hours that do not count:

 

 

 

 

 

Curr GPA:

 

 

 

CUM:

 

 

Curr GPA:

 

 

CGPA:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2) Total Hours Rqd for NAPS:

 

 

 

 

 

Term:

 

 

 

 

 

 

 

 

 

Term:

 

 

 

 

 

 

 

 

 

 

 

b. HOST SCHOOL

 

 

c. HOST FICE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Normal Academic Progression Standard

 

 

 

 

 

Curr GPA:

 

 

 

CUM:

 

 

Curr GPA:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CGPA:

 

 

 

 

 

 

 

 

 

 

b. Credits toward degree Comp to date:

 

 

 

 

 

Term:

 

 

 

 

 

 

 

 

 

Term:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c. Transfer Credits accepted:

 

 

 

 

 

Curr GPA:

 

 

 

CUM:

 

 

Curr GPA:

 

 

CGPA:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d. Remaining for Degree:

 

 

 

 

 

Term:

 

 

 

 

 

 

 

 

 

Term:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

e. Number of authorized S/Qs:

 

 

 

 

 

Curr GPA:

 

 

 

CUM:

 

 

 

 

Curr GPA:

 

 

CGPA:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.TERM, YEAR, COURSE NUMBER, COURSE TITLE, COURSE CREDIT HOURS, CREDITS THAT COUNT TOWARDS ACADEMIC DEGREE, AND ACHIEVED GRADES.

a.

Term:

 

Year:

No.

Course Title

Hrs. Cts. Grd.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Term Hours:

d.

Term:

 

Year:

No.

Course Title

Hrs. Cts. Grd.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Term Hours:

b.

 

Term:

 

Year:

 

No.

Course Title

Hrs. Cts. Grd.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Term Hours:

e.

Term:

 

Year:

No.

 

Course Title

Hrs. Cts. Grd.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Term Hours:

c.

Term:

 

Year:

No.

Course Title

Hrs. Cts. Grd.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Term Hours:

f.

Term:

 

Year:

 

 

 

No.

Course Title

Hrs. Cts. Grd.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Term Hours:

8. STUDENT INITIALS & DATE:

(Have the student initial and date beside each term to indicate they have been counseled)

TERM 1:

TERM 2:

TERM 3:

TERM 4:

 

TERM 7:

TERM 5:

 

TERM 8:

 

TERM 6:

 

TERM 9:

 

USACC Form 104-R, SEP 13

Page 1 of 3

PLANNED ACADEMIC PROGRAM WORKSHEET

For use of this form, see USACC Pam 145-4, the proponent agency is ATCC-PA-C

7.TERM, YEAR, COURSE NUMBER, COURSE TITLE, COURSE CREDIT HOURS, CREDITS THAT COUNT TOWARDS ACADEMIC DEGREE, AND ACHIEVED GRADES. (CONTINUED)

g.

Term:

 

Year:

No.

Course Title

Hrs. Cts. Grd.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Term Hours:

h.

Term:

 

Year:

No.

Course Title

Hrs. Cts. Grd.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Term Hours:

i.

Term:

 

Year:

No.

Course Title

Hrs. Cts. Grd.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Term Hours:

 

j.

 

 

 

k.

 

 

 

l.

 

Term:

 

Year:

 

Term:

 

Year:

 

Term:

 

Year:

No.

Course Title

Hrs. Cts. Grd.

 

No.

Course Title

Hrs. Cts. Grd.

 

No.

Course Title

Hrs. Cts. Grd.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Term Hours:

 

 

 

 

 

Total Term Hours:

 

 

 

 

 

Total Term Hours:

 

 

 

 

 

 

m.

 

 

 

 

 

 

n.

 

 

 

 

 

o.

 

 

 

 

 

Term:

 

 

Year:

 

Term:

 

 

Year:

 

Term:

 

 

Year:

 

 

No.

Course Title

Hrs.

Cts.

Grd.

 

No.

 

Course Title

Hrs.

Cts.

Grd.

 

No.

Course Title

Hrs.

Cts.

Grd.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Term Hours:

 

 

 

 

 

Total Term Hours:

 

 

 

 

 

Total Term Hours:

 

 

 

 

 

 

 

 

 

 

 

 

9. REVIEW: All of the above courses are required (as minimum) for the completion of the degree:

YES

 

NO (if no, list exceptions on reverside of this form).

 

 

 

 

Completion should result in

degree, during (Month, Year):

 

 

 

 

 

 

 

10.

SIGNATURE OF STUDENT:

 

11.

DATE: (MM/DD/YYYY)

 

 

 

 

12.

SIGNATURE OF REGISTRAR AND EXAMINER OF CREDENTIALS (OR OTHER INSTITUTION CERTIFYING OFFICIAL):

13.

DATE: (MM/DD/YYYY)

 

 

 

 

 

USACC Form 104-R, SEP 13

Page 2 of 3

 

 

 

PLANNED ACADEMIC PROGRAM WORKSHEET

 

 

 

For use of this form, see USACC Pam 145-4, the proponent agency is ATCC-PA-C

 

 

 

 

 

 

 

 

 

 

STATEMENT OF UNDERSTANDING

We, the undersigned, hereby declare that the program outlined on the worksheet (on the reverse side of this statement) that

Cadet

 

is about to under take a formally structured program approved by

 

 

 

(FULL NAME, Last, First, MI)

 

 

(Name of University or College)

designed to meet the requirments of a

 

 

degree; that the degree to be attained is the culmination of an

 

 

 

(Type of Degree)

undergraduate college program of at least four years; and that the remaining credit hours shown on the worksheet are necessary either to fulfill

discipline requirements or to fulfill credit hour requirements, or both, for the attainment of the degree. If the Cadet is an ROTC Scholarship

participant, the scholarship will be in force for the number of semesters indicated in Block 5.

(Date) (MM/DD/YYYY)

(CADET SIGNATURE)

(Date) (MM/DD/YYYY)

(PROFESSOR OF MILITARY SCIENCE SIGNATURE)

USACC Form 104-R, SEP 13

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