Fill in a Valid 104 R Template

The 104 R form is a Planned Academic Program Worksheet used by the Army Senior ROTC program. This form collects essential information to assess a student's eligibility for commissioning in the Army, ensuring they meet the necessary academic requirements. It serves as a roadmap for students, outlining their academic journey and helping them achieve their degree goals.

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Table of Contents

The 104 R form, known as the Planned Academic Program Worksheet, plays a crucial role in the Army Senior ROTC program. This form is essential for students seeking commissioning in the Army, as it helps to outline their academic trajectory over the remaining years of study. It gathers vital information, including the student’s name, academic major, and grade point average, which are necessary for assessing eligibility for the program. Students must detail their course selections, credit hours, and grades achieved, ensuring that their academic plans align with the requirements set forth by public law and Army regulations. Additionally, the form emphasizes the importance of voluntary disclosure, as it impacts a student’s acceptance and continuation in the ROTC program. Completing the 104 R form requires careful attention to detail, as it not only serves as a record of academic progress but also assists in determining whether students meet the criteria for their degree completion. Ultimately, this form is a pivotal component in the management and processing of ROTC students, ensuring they remain on track for successful commissioning into the Army.

Documents used along the form

The 104 R form, also known as the Planned Academic Program Worksheet, is essential for students participating in the Army Senior ROTC program. Alongside this form, several other documents are often required to ensure that students are on track to meet their academic and programmatic goals. Below is a list of additional forms and documents that are commonly used in conjunction with the 104 R form.

ROTC Scholarship Application: This document is crucial for students seeking financial assistance through the ROTC program. It collects personal, academic, and financial information to determine eligibility for scholarships.
Articles of Incorporation Form: For cadets looking to formalize their business entity, completing the California PDF Forms is essential to ensure legal establishment.
Cadet Command Form 145-1: This form is used to track a cadet's academic performance and participation in ROTC activities. It helps ensure that cadets are meeting the program's standards and requirements.
Transcript Request Form: Students must submit this form to their educational institution to obtain official transcripts. Transcripts provide a comprehensive record of a student’s academic history, which is necessary for evaluating progress toward degree completion.
Degree Plan: This document outlines the courses a student needs to complete their degree. It serves as a roadmap for students, ensuring they understand the requirements and can plan their semesters accordingly.
Student Counseling Form: This form is used to document meetings between cadets and academic advisors. It captures discussions about academic progress, course selections, and any challenges the cadet may be facing.
Scholarship Acceptance Agreement: This agreement is signed by cadets who receive ROTC scholarships. It outlines the terms and conditions of the scholarship, including service commitments and academic performance expectations.

Each of these documents plays a vital role in supporting the academic and military training of cadets. They help ensure that students are well-informed, properly guided, and adequately prepared to meet the demands of both their educational and military commitments.

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104 R Example

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:

a. IDENTIFICATION (Check one):

Host

Curr GPA:

CUM:

Curr GPA:

CGPA:

Extension Center

a. Total required for degree:

Term:

Cross-Enrolled

(1) ROTC Hours that do not count:

Curr GPA:

CUM:

Curr GPA:

CGPA:

(2) Total Hours Rqd for NAPS:

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:

c. Transfer Credits accepted:

Curr GPA:

CUM:

Curr GPA:

CGPA:

d. Remaining for Degree:

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.

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

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)

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

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:

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:

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

FAQ

What is the purpose of the 104 R form?

The 104 R form, officially known as the Planned Academic Program Worksheet, serves a crucial role in the Army Senior ROTC program. It collects essential information about a cadet’s academic journey, ensuring they meet the public law requirements for commissioning in the Army. By outlining a projected academic plan, this form helps determine if the cadet has two remaining academic years to complete their degree. It is a vital tool for both the cadet and the institution in managing academic progress.

Who needs to fill out the 104 R form?

This form is primarily intended for students participating in the Army ROTC program. Specifically, cadets who are working towards commissioning in the Army must complete this worksheet. It is essential for those who are either applying for the program or are already enrolled and need to document their academic progress. Additionally, academic advisors and ROTC instructors may assist in the completion of this form to ensure accuracy and compliance with program requirements.

What information is required on the 104 R form?

The 104 R form requires various details, including:

Student’s name and academic major
CIP code associated with the major
Current academic status, including GPA and credit hours
Details of courses taken, including course number, title, credit hours, and grades
Signatures from the student and academic officials to confirm the information

This information collectively helps assess whether the cadet is on track to complete their degree requirements within the designated timeframe.

What happens if a cadet does not provide the required information?

Voluntary disclosure of information on the 104 R form is crucial for determining a cadet’s eligibility for acceptance or continuance in the Army ROTC program. If a cadet fails to provide the necessary information, it may hinder their ability to progress in the program. Incomplete or inaccurate submissions can lead to delays in processing or even disqualification from the ROTC program. Therefore, it is imperative for cadets to complete the form thoroughly and accurately.

How does the 104 R form affect a cadet's scholarship status?

If a cadet is a participant 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 required to complete their degree, which directly impacts the duration of the scholarship. It ensures that the scholarship remains in force for the number of semesters indicated on the form. Hence, it is essential for cadets to keep this form updated to reflect their academic progress accurately.

Key takeaways

The 104 R form is essential for students in the Army Senior ROTC program to outline their academic plans.
Students must provide their name, academic major, and other personal details accurately to ensure proper processing.
It is important to list all courses, including credit hours and grades, to reflect the student’s academic progress.
Students should verify that all courses listed are necessary for their degree completion, marking any exceptions if needed.
Both the student and the registrar must sign and date the form to confirm the information provided is correct and complete.

Form Characteristics

Fact Name	Details
Form Purpose	This form collects data for managing students in the Army Senior ROTC program.
Governing Authority	Title 10, US Code sections 2101 and 2104 govern the use of this form.
Privacy Act Compliance	Information collected complies with the Privacy Act Statement of 1974.
Voluntary Disclosure	Providing information is voluntary but necessary for eligibility determination.
Academic Requirements	The form outlines courses and credits required for degree completion.