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The 104 R form serves as a crucial tool for students participating in the Army Senior ROTC program, providing a structured approach to planning their academic journey. This worksheet is designed to gather essential information about a cadet's academic program, including their major, credit hours, and grade point average. It plays a key role in assessing whether students meet the public law requirements for completing their degree within the designated timeframe. The form requires students to outline their course selections, detailing the term, year, course number, title, credit hours, and achieved grades. By doing so, it ensures that all necessary courses are accounted for in the pursuit of their degree. Additionally, the 104 R form includes a statement of understanding, where students confirm their commitment to a structured program approved by their educational institution. This document not only helps in managing the ROTC program but also aids in determining the eligibility of students for continued participation. Overall, the 104 R form is an essential component of the academic planning process for ROTC cadets, guiding them toward successful completion of their educational goals.

Dos and Don'ts

When filling out the 104 R form, it is essential to follow specific guidelines to ensure accuracy and compliance. Here is a list of things you should and shouldn't do:

  • Do provide your full name, including last name, first name, and middle initial.
  • Do accurately fill in your academic major and corresponding CIP code.
  • Do ensure that the date is formatted correctly (MM/DD/YYYY).
  • Do list all courses taken, including course numbers, titles, credit hours, and grades.
  • Do indicate whether the courses listed are required for your degree completion.
  • Don't leave any fields blank; all required information must be completed.
  • Don't use abbreviations or shorthand that may confuse the reviewers.
  • Don't forget to sign and date the form where indicated.
  • Don't submit the form without verifying that all information is accurate.
  • Don't ignore instructions regarding the number of authorized semesters or quarters.

Document Attributes

Fact Name Description
Form Title The form is officially titled "Planned Academic Program Worksheet." It is used for Army Senior ROTC program participants.
Governing Authority This form is governed by Title 10 of the U.S. Code, specifically sections 2101 and 2104.
Purpose of the Form The primary purpose is to collect data necessary for managing ROTC students and ensuring they meet commissioning requirements.
Privacy Act Compliance The form complies with the Privacy Act Statement of 1974, ensuring that personal information is handled properly.
Voluntary Disclosure Providing information on this form is voluntary, but it is essential for determining eligibility in the ROTC program.
Required Information Students must provide their name, academic major, CIP code, and other academic details as part of the form.
Academic Progress Tracking The form helps track a student's academic progress and ensure they are on track to complete their degree.
Course Information Students need to list courses taken, including course titles, credit hours, and grades, for each term.
Signatures Required Signatures from the student, registrar, and professor of military science are required to validate the information provided.
Completion Confirmation The form includes a review section where students confirm that all listed courses are required for their degree completion.

Key takeaways

When filling out and using the 104 R form, keep these key takeaways in mind:

  • Purpose: The form is designed to gather essential information for managing students in the Army Senior ROTC program.
  • Voluntary Disclosure: Providing information is voluntary but necessary for determining eligibility in the program.
  • Accurate Information: Ensure that all personal and academic details are accurate to avoid delays in processing.
  • Academic Major: Clearly state your academic major and include the corresponding CIP code.
  • Credit Hours: List total required credit hours for your degree and track your progress toward completion.
  • GPA Tracking: Keep a record of your current and cumulative GPA as it impacts your eligibility.
  • Course Listings: Detail all courses taken, including course numbers, titles, credit hours, and grades achieved.
  • Initials Required: Students must initial and date beside each term to confirm counseling and understanding.
  • Review Requirements: Indicate whether all listed courses are required for degree completion.
  • Signatures: Obtain necessary signatures from both the student and the certifying official to validate the form.

By following these guidelines, you can ensure a smoother experience with the 104 R form.

Example - 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

Page 3 of 3

Detailed Instructions for Writing 104 R

Completing the 104 R form is an essential step for students involved in the Army Senior ROTC program. It helps outline your academic plan and ensures you meet the necessary requirements for commissioning. Follow these steps carefully to fill out the form accurately.

  1. Enter Your Name: Write your last name, first name, and middle initial in the designated space.
  2. Academic Major: Specify your major field of study.
  3. CIP Code: Fill in the Classification of Instructional Programs (CIP) code associated with your major.
  4. Date of Form Preparation: Enter the date using the format MM/DD/YYYY.
  5. Academic School: Indicate the name of your academic institution.
  6. Credit Hours: List the total credit hours required for your degree.
  7. Grade Point Average (GPA): Provide your current GPA and cumulative GPA.
  8. Select Semester or Quarter: Check the appropriate box for semester or quarter system.
  9. Identify Your School: Indicate whether you are enrolled in a host school, extension center, or cross-enrolled.
  10. Fill in Course Details: For each term, list the year, course number, course title, credit hours, credits that count toward your degree, and achieved grades.
  11. Initials and Dates: Have the student initial and date beside each term to confirm counseling.
  12. Review Course Requirements: Confirm if all listed courses are required for degree completion by marking 'YES' or 'NO'. If 'NO', provide exceptions on the back of the form.
  13. Student Signature: Sign and date the form in the designated area.
  14. Registrar Signature: Obtain the signature of the registrar or certifying official and date it.

After completing the form, ensure all sections are filled out accurately. Gather any necessary signatures and submit it according to your institution's guidelines. This form is crucial for your academic progress and ROTC participation.

Documents used along the form

When navigating the complexities of academic programs within the Army ROTC, several forms and documents are often utilized alongside the 104 R form. Each of these documents plays a critical role in ensuring that students meet the necessary requirements for their educational and military commitments. Understanding these forms can help streamline the process and support students in their academic journey.

  • ROTC Scholarship Application: This form is essential for students seeking financial assistance through the ROTC program. It collects personal information, academic achievements, and extracurricular activities, helping to determine eligibility for scholarships that can significantly ease the financial burden of college education.
  • Cadet Enrollment Agreement: This document outlines the terms and conditions of a cadet's participation in the ROTC program. It includes commitments related to service obligations, academic performance, and potential consequences for non-compliance, ensuring that cadets understand their responsibilities as they pursue their education and military training.
  • Dirt Bike Bill of Sale: This essential document records the sale of a dirt bike, providing proof of purchase and protecting the rights of both seller and buyer. For more information, you can refer to newyorkform.com/free-dirt-bike-bill-of-sale-template/.
  • Academic Advising Form: This form is used to document meetings between cadets and academic advisors. It provides a record of course selections, degree requirements, and any adjustments made to academic plans. This communication is vital for keeping cadets on track toward graduation while fulfilling ROTC obligations.
  • Transfer Credit Evaluation: For students who have previously attended other institutions, this document assesses which credits can be transferred to their current academic program. It helps ensure that students receive appropriate credit for their prior coursework, facilitating a smoother transition into their new program.

By familiarizing themselves with these forms, students can better navigate their academic and ROTC commitments. Each document serves a specific purpose, contributing to a comprehensive understanding of the requirements and expectations within the program. This knowledge empowers cadets to take charge of their educational paths and fulfill their aspirations.