Printable 104 R Template

The 104 R form is a Planned Academic Program Worksheet used within the Army Senior ROTC program. This form collects essential information about a student's academic plan to ensure they meet the necessary requirements for commissioning in the Army. Completing this form accurately is crucial for your eligibility and continued participation in the program.

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The 104 R form, known as the Planned Academic Program Worksheet, serves a vital role in the Army Senior ROTC program. This document is designed to collect essential information about a student’s academic journey, helping to ensure that they meet the necessary requirements for commissioning in the Army. It includes sections for personal details, academic major, credit hours, and grade point averages. The form also outlines the courses the student has completed or plans to take, along with the corresponding credit hours and grades. By providing a clear academic plan, the 104 R form helps both students and advisors track progress and identify any remaining requirements for degree completion. Furthermore, it emphasizes the importance of voluntary disclosure, as the information provided is crucial for determining eligibility for continued participation in the ROTC program. Understanding this form can significantly impact a student’s academic and military career, making it an essential tool for those on the path to commissioning.

Common mistakes

Not including the full name of the student in the designated field can lead to confusion and delays in processing.
Failing to provide the correct academic major or the corresponding CIP code may result in issues with eligibility.
Leaving the as of date blank or incorrectly formatted can cause administrative complications.
Not specifying the academic school accurately can hinder the evaluation of the student's academic plan.
Omitting or incorrectly calculating credit hours may affect the assessment of academic progress.
Failing to report the correct grade point average (GPA) can lead to misunderstandings regarding academic standing.
Not checking the appropriate identification box can create confusion about the student's enrollment status.
Inaccurate reporting of course details, such as credit hours and grades, may result in discrepancies in the academic record.
Neglecting to have the student initial and date each term can lead to questions about counseling and understanding of the academic plan.

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Key takeaways

When filling out the 104 R form, it is essential to understand its purpose and requirements. Here are some key takeaways:

Purpose: The 104 R form is used to create a planned academic program for students in the Army Senior ROTC program.
Eligibility: Completing this form helps determine if the applicant meets the public law requirements for remaining academic years.
Voluntary Disclosure: Providing information is voluntary but necessary for assessing eligibility for the ROTC program.
Student Information: Ensure the student's name, academic major, and CIP code are accurately filled out at the top of the form.
Academic Progress: Include credit hours and GPA to reflect the student's current academic standing and progress toward their degree.
Course Details: List all relevant courses, including course numbers, titles, credit hours, and achieved grades for each term.
Counseling Requirement: The student must initial and date beside each term to confirm they have received academic counseling.
Review Section: Check the box indicating whether all listed courses are required for degree completion.
Signatures: Obtain the necessary signatures from the student and the certifying official to validate the form.

Completing the 104 R form accurately is crucial for students in the ROTC program. It ensures that they remain on track for their academic and commissioning goals.

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

Understanding 104 R

What is the purpose of the 104 R form?

The 104 R form, also known as the Planned Academic Program Worksheet, is designed to help manage and administer the Army Senior ROTC program. It collects essential information about a student's academic plan, ensuring they meet the necessary requirements for commissioning in the Army.

Who needs to fill out the 104 R form?

This form is typically filled out by students enrolled in the Army ROTC program. It is crucial for those who are seeking to demonstrate their academic progress and eligibility for continued participation in the program.

What information is required on the 104 R form?

The form requests various details, including:

Name of the student
Academic major and CIP code
Academic school and credit hours
Grade Point Average (GPA)
Course details for each term, including course number, title, credit hours, and grades

All this information helps in evaluating the student’s academic standing and progress towards their degree.

How does the 104 R form affect my ROTC scholarship?

If you are a participant in the ROTC Scholarship program, the completion of the 104 R form is vital. It indicates the number of semesters your scholarship will cover, based on the academic plan outlined in the form. This helps ensure that you remain eligible for funding throughout your studies.

What happens if I don’t provide the requested information?

Providing the information on the 104 R form is voluntary, but it is strongly encouraged. Failing to submit the required details may impact your eligibility for acceptance, continuation, or even discontinuation in the Army ROTC program.

What is the review process for the 104 R form?

Once completed, the form must be reviewed to confirm that all courses listed are necessary for degree completion. A certification from the registrar or another official is required to validate the information provided. This review ensures that the academic plan aligns with the degree requirements.

How do I know if my academic plan is acceptable?

Your academic plan will be considered acceptable if it meets the minimum requirements for your degree. The form includes a section for you to indicate whether all courses listed are required. If any exceptions exist, you should note them on the back of the form.

What should I do if I have questions about filling out the form?

If you have questions or need assistance with the 104 R form, it is advisable to reach out to your academic advisor or the Professor of Military Science. They can provide guidance and ensure that you accurately complete the form to meet all necessary requirements.

How to Use 104 R

After gathering all necessary information, proceed to fill out the 104 R form accurately. This form is crucial for your academic planning within the Army Senior ROTC program. Make sure to double-check your entries for accuracy before submission.

Fill in the student’s name: Enter the last name, first name, and middle initial in the designated fields.
Indicate the academic major: Write down the major you are pursuing.
Provide the CIP code: Enter the Classification of Instructional Programs (CIP) code for your major.
Enter the date: Fill in the date when you are preparing the form in MM/DD/YYYY format.
List the academic school: Write the name of the institution you are attending.
Fill in credit hours: Enter the total number of credit hours required for your degree.
Record your GPA: Provide your current Grade Point Average (GPA) and cumulative GPA.
Select semester or quarter: Check the appropriate box for Semester or Quarter.
Complete the course information: For each term, list the course number, title, credit hours, credits that count towards your degree, and achieved grades.
Initial and date: Have the student initial and date beside each term to indicate they have been counseled.
Review course requirements: Indicate whether all listed courses are required for degree completion by checking 'YES' or 'NO.'
Sign the form: The student must sign and date the form. The registrar or certifying official must also sign and date it.
Complete the statement of understanding: Ensure that all parties involved sign and date the statement of understanding at the end of the form.