Homepage Fill Out Your 104 R Form
Article Structure

The 104 R form, known as the Planned Academic Program Worksheet, plays a critical role in the Army Senior ROTC program, serving as a key document for both students and academic institutions. This form is designed to gather essential information that showcases a student’s academic trajectory and ultimately determines their eligibility for commissioning into the Army. Each section of the form captures vital details such as the student’s name, academic major, credit hours, and grade point average, ensuring a comprehensive overview of their progress towards degree completion. Moreover, the 104 R form requires students to outline their planned courses, specifying credit hours and grades achieved, which helps both the student and the Army assess adherence to public law requirements for maintaining ROTC participation. With the added stipulations surrounding voluntary information disclosure, students are prompted to actively engage in self-assessment, providing a clear pathway to eligibility evaluations. It is imperative for students to understand the urgency of filling out this form accurately and promptly, as it directly impacts their academic standing and future opportunities within the Army ROTC program. Compliance and diligence in this process will significantly influence a cadet’s success in completing their educational objectives and fulfilling their duties as future Army leaders.

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:

 

 

 

 

 

 

 

 

 

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

Form Characteristics

Fact Name Detail
Form Purpose The 104 R form is used to provide a planned academic program for ROTC students.
Governing Law Federal regulations specify its use under Title 10, US Code 2101 and 2104.
Privacy Act Compliance This form complies with the Privacy Act of 1974, mandating data protection.
Voluntary Disclosure Submission of information is voluntary, affecting ROTC eligibility and status.
Data Requirements It collects data on academic major, credit hours, and courses for degree progression.
Principal Use Information assists in determining if students can complete the ROTC program.

Guidelines on Utilizing 104 R

Completing the 104 R form is an important task for students in the Army Senior ROTC program. This form tracks academic progress and ensures the necessary requirements for graduation are met. Follow these steps to accurately fill out the form.

  1. Enter Student Information: Fill in the student’s full name (last, first, middle initial) in the designated section.
  2. Specify Academic Major: Write the name of the student’s major in the provided field.
  3. Provide CIP Code: Enter the Classification of Instructional Programs (CIP) code related to the academic major.
  4. Input Date: Indicate the date the form is being prepared in MM/DD/YYYY format.
  5. Identify Academic School: State the name of the school the student is attending.
  6. Document Credit Hours: Enter the total credit hours required for the student’s degree program.
  7. Record GPA: Fill in the student’s current Grade Point Average (GPA) in the appropriate sections for both cumulative and current grades.
  8. Specify Terms: Choose whether the student is in a semester or quarter system, and specify the term(s) being reported.
  9. List Courses: For each term, provide information on course number, title, credit hours, grades, and credits that count towards the degree. Repeat for each course listed.
  10. Initial and Date: Have the student initial and date each term to confirm they have been counseled on their academic progress.
  11. Review Course Requirements: Indicate if all listed courses are required for the completion of the degree.
  12. Student Signature: Have the student sign and date the form.
  13. Registrar Signature: Obtain the signature of the registrar or certifying official and date it.

Once the form is filled out and all signatures are acquired, it is crucial to review the information for accuracy. Ensure all entries are clear and legible before submitting the form as required for the Army ROTC program.

What You Should Know About This Form

What is the purpose of the 104 R form?

The 104 R form, officially known as the Planned Academic Program Worksheet, serves a fundamental role in managing and administering the Army Senior ROTC program. It collects essential information regarding a student's academic progress and future plans. The form helps determine whether applicants meet the academic requirements outlined by public law for commissioning into the Army. It is a crucial tool for evaluating eligibility, tracking academic performance, and ensuring that students are on the right path to complete their degree requirements.

Who needs to complete the 104 R form?

Students participating in the Army ROTC program are the primary individuals required to complete the 104 R form. This includes cadets who have received ROTC scholarships or are otherwise selected for the program. It is essential that these students provide accurate and complete information about their academic majors, credit hours, and grades. Completing the form is a voluntary process, but it is critical for a student’s acceptance and continued participation in the ROTC program.

What information must be included in the 104 R form?

The 104 R form requires various information to be filled out. First, the student's name, academic major, and the academic institution must be listed. It also requires details about credit hours and the student's grade point average (GPA). Additionally, students must document their course history, including course titles, credit hours, and grades received for each term. This comprehensive data allows the institution to review the academic plan effectively and assess the student's progress towards their degree.

What happens if a student does not provide the necessary information on the 104 R form?

If a student fails to provide the required information on the 104 R form, it may lead to complications regarding their eligibility for the Army ROTC program. Incomplete submissions could impede the processing of their academic plans and delay the assessment of their status within the program. This could ultimately affect a student's commissioning prospects or scholarship eligibility. Thus, it is vital that students ensure all information is complete and accurate to avoid any negative consequences.

Common mistakes

Completing the 104 R form can feel overwhelming, and many individuals stumble on key areas. Below are some common mistakes to avoid.

1. Incomplete Information: Many people skip critical sections of the form. Missing data such as the student’s name, academic major, or GPA can delay processing. Always double-check that every section is filled out completely.

2. Incorrect Course Information: Listing an incorrect course number or title is another frequent error. Each course should be accurately detailed, including credit hours and achieved grades. Ensure that this information is consistent with what is reflected in academic records.

3. Failing to Include Signatures: Not obtaining the necessary signatures can halt progress on your application. The form requires the signatures of both the student and the academic official. Ensure you complete this step to avoid setbacks.

4. Misunderstanding Credit Requirements: Applicants often miscalculate their remaining credit hours. Carefully review your program requirements to ensure that the hours you list correspond with the degree needs. This step is vital for your eligibility in the ROTC program.

5. Not Initialing Terms: Each term on the form requires the student to initial and date it. Failure to do so suggests incomplete counseling. This simple act can signify that you are aware and accountable for your academic journey.

6. Ignoring Privacy Act Guidelines: Many individuals overlook the Privacy Act statement section. Familiarizing yourself with this information helps clarify the management of your data and ensures you're comfortable with how your information will be handled.

7. Submitting Late: Timeframes can be critical. Submitting the form late can jeopardize your standing in the ROTC program. Always be aware of deadlines and ensure you allocate enough time for a thorough review prior to submission.

Being aware of these common pitfalls can lead to a smoother and more efficient completion of the 104 R form. Take your time, and don’t hesitate to seek help if needed.

Documents used along the form

The 104 R form, known as the Planned Academic Program Worksheet, is essential for managing academic progress within the Army Senior ROTC program. However, it often accompanies several other forms and documents that help further facilitate the administrative process. Below is a list of some commonly used forms alongside the 104 R form, each serving a specific purpose.

  • USACC Form 105-R: This form is utilized to report the performance and academic progress of cadets. It includes evaluations of coursework and overall conduct, which are critical for determining continued eligibility in the ROTC program.
  • ROTC Scholarship Application: The scholarship application evaluates candidates for financial aid based on various factors, including academic performance, commitment, and future potential in the Army. This form must be filled out by interested applicants.
  • Academic Transcript: An academic transcript provides an official record of a student's coursework and grades. It is essential for assessing eligibility for the ROTC program as it shows compliance with academic standards and progress toward degree completion.
  • Declaration of Major Form: This document officially declares a student's chosen field of study at their institution. It is necessary for aligning the cadet's academic program with their ROTC requirements and maintaining their academic standing.
  • Student Personal Profile: This form collects personal and demographic information about the cadet. It plays a significant role in establishing eligibility for various programs and scholarships, ensuring that all candidates are accurately represented.

In summary, these documents work together to support cadets in their academic journey within the ROTC program. They ensure all requirements are met and aid in the seamless administration of necessary processes. Each document plays its part in shaping a well-rounded academic experience for future leaders in the Army.

Similar forms

The 104 R form, known as the Planned Academic Program Worksheet, serves as a crucial document within the Army Senior ROTC program. Several other educational and administrative forms share similar functions or objectives, facilitating the assessment and management of academic progress. Below are eight documents that bear resemblance to the 104 R form:

  • Degree Evaluation Form: This document outlines a student's completed and remaining courses necessary for graduation, much like the 104 R form summarizes academic progress and requirements.
  • Academic Advisor Worksheet: Similar in purpose, this form assists advisors in tracking a student's educational trajectory, providing a comprehensive plan for course completion.
  • Transfer Credit Evaluation: Both forms help ensure that students meet their degree requirements, with the transfer credit evaluation focusing on credits earned outside the institution.
  • Course Registration Form: Like the 104 R form, this document is used to plan out course selections for upcoming semesters, essential for maintaining academic progression.
  • Financial Aid Academic Progress Report: With a focus on academic performance, this report assesses whether students continue to meet eligibility criteria for financial aid, paralleling the evaluations in the 104 R form.
  • Program of Study Form: This document defines a student’s course of study requirements, similar to how the 104 R outlines the necessary academic plan for ROTC participants.
  • Degree Plan Template: Used primarily by military personnel, this form serves as a roadmap to fulfill all degree requirements, much like the structured guidance provided in the 104 R form.
  • Cumulative Academic Record: Similar to the 104 R form, this record details all coursework and grades, ensuring comprehensive oversight of a student’s academic journey.

Dos and Don'ts

When filling out the 104 R form, it’s crucial to take care with the details. Here are six things you should and shouldn't do:

  • Do review the entire form carefully. Make sure you understand each section before starting.
  • Don't rush through the process. Take your time to ensure accuracy.
  • Do provide complete information. Every section requires your input for the form to be valid.
  • Don't leave any sections blank. If a question doesn't apply, write "N/A" to indicate it was not overlooked.
  • Do seek help if needed. Consult academic advisors or instructors if unsure about any part of the form.
  • Don't forget to sign and date the form. Missing signatures can delay processing.

Misconceptions

Misunderstandings about the 104 R form are common. Below are eight prevalent misconceptions, along with clarifications to enhance understanding.

  • The 104 R form is only for Army ROTC students. Many believe this form is exclusive to Army ROTC participants. In reality, it is also applicable to other programs and can be useful for any student pursuing a commission in the Army.
  • Completing the form guarantees acceptance into the Army ROTC program. A common error is assuming that filling out the form secures a place in the program. Acceptance depends on various factors including academic performance and eligibility under Army regulations.
  • Only current college students need to use the 104 R form. Prospective students often overlook the significance of this form. It can also play a crucial role for high school students planning to apply for ROTC in college.
  • The form is not important for degree planning. Some may dismiss the form, thinking it has no bearing on their academic trajectory. However, it actually assists in mapping out the courses needed for degree completion.
  • Providing information on the form is mandatory. There is a belief that all requested information must be provided. In fact, while filling out the form is essential, it is emphasized that certain details can be given voluntarily.
  • The 104 R form only tracks grades. Many users mistakenly think it solely focuses on academic performance. In truth, the form encompasses overall academic planning, including course selection and credit requirements.
  • Counseling is optional before submitting the form. Some students might think counseling is unnecessary. However, it is highly recommended for ensuring the form is completed accurately and to provide guidance on academic progress.
  • Signatures on the form are not significant. It is often assumed that the signatures required on the form are mere formalities. In reality, these signatures affirm that both the student and the institution's representatives agree on the academic plan outlined.

Key takeaways

The 104 R form, known as the Planned Academic Program Worksheet, serves as a valuable tool for both students and academic advisors within the Army ROTC program. Below are key takeaways regarding its usage:

  • Purpose of the Form: The 104 R form collects necessary information to support the administration of the Army Senior ROTC program and to confirm that students meet aspects of public law for commissioning.
  • Information Required: Students must provide personal details, such as their name, academic major, CIP code, and academic school, along with specifics about their planned courses and credits.
  • Student Participation: Completing the form is voluntary but essential. It influences a student's eligibility for acceptance, continuance, or discontinuance in the ROTC program.
  • Term and Course Details: The form includes sections to list courses by term, where students specify course titles, credit hours, and the grades they anticipate achieving.
  • Counseling Validation: Students are required to initial and date beside each term indicated on the form. This acknowledges that they have received counseling regarding their academic plan.
  • Final Review and Signatures: The student and the registrar or another certifying official must sign the form to confirm the information is accurate and that the coursework is necessary for degree completion.