104 R Template

104 R Template

The 104 R form, also known as the Planned Academic Program Worksheet, is essential for students in the Army Senior ROTC program. This form collects information necessary for managing students and ensuring they meet the academic requirements for commissioning in the Army. Completing this form accurately is crucial for the eligibility and continuation in the ROTC program.

To fill out the form, please click the button below.

Content Overview

The 104 R form, officially known as the Planned Academic Program Worksheet, plays a vital role in the administration of the Army Senior ROTC program. This form collects specific information from students to ensure they meet the requirements for commissioning in the Army. Designed with both the student and the administrative needs of the ROTC in mind, it is essential for managing academic progress over the remaining years of study. Users must provide key details, such as their name, academic major, and credit hours, along with a structured outline of their courses, grades, and grade point average (GPA). The contents of this form help verify that applicants comply with public law requirements, establishing their qualifications for continued participation in the ROTC program. Students are encouraged to disclose pertinent information voluntarily, as this will influence their eligibility status. The form culminates in an official acknowledgment from both the student and the registrar, ensuring that all data is accurate and reflective of the academic path needed to obtain a degree. By outlining current and future courses, it assists in tracking academic progress, thereby enhancing accountability within the ROTC structure.

104 R Sample

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

Document Attributes

Fact Name Description
Purpose The 104-R form is crucial for creating an organized academic plan, ensuring that students meet the necessary qualifications for the Army Senior ROTC program.
Governing Law This form operates under the authority of Title 10, U.S. Code sections 2101 and 2104, which establish the framework for ROTC programs.
Privacy Requirements In compliance with the Privacy Act of 1974, personal information collected via this form is protected and used solely for administrative purposes within the Army ROTC program.
Voluntary Disclosure Providing information on the 104-R form is voluntary, but it is essential for determining eligibility and continuation in the ROTC program.

104 R: Usage Instruction

After you've gathered all necessary information, it's time to complete the 104 R form. Ensure that you have accurate details on academic progress, courses, and signatures ready to go. Follow the steps below to fill out the form correctly.

  1. Enter the student's name in the format: Last, First, MI.
  2. Fill in the academic major.
  3. Provide the CIP code associated with the academic major.
  4. Enter the preparation date in MM/DD/YYYY format.
  5. Indicate the academic school the student is attending.
  6. Insert the total credit hours required for the degree.
  7. Fill in the current grade point average (GPA) for both the semester and cumulative GPA. Select whether it’s a semester or quarter.
  8. List the academic terms, year, course number, course title, course credit hours, the number of credits that count towards the degree, and achieved grades, across the provided sections.
  9. Have the student initial and date next to each term to confirm counseling on academic progress.
  10. Indicate if all listed courses are required for degree completion by marking YES or NO, and note any exceptions on the reverse side of the form if applicable.
  11. Include the date when the degree is expected to be completed.
  12. Ensure the student signs the form.
  13. Fill in the date of the student’s signature in MM/DD/YYYY format.
  14. Obtain the signature of the registrar or other certifying official and record the date in MM/DD/YYYY format.
  15. Sign the statement of understanding at the bottom of the form, including the professor of military science’s signature and the respective dates.

Completing the form accurately is crucial for processing and managing academic records efficiently. Make sure to double-check all entries before submission.

Frequently Asked Questions

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

    The 104 R form, officially known as the Planned Academic Program Worksheet, is essential for managing the Army Senior ROTC program. This form collects important information regarding students to ensure they meet public law requirements for commissioning in the Army.

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

    This form is required to be completed by students participating in the Army ROTC program. It serves to outline their academic plans for the next two years, ensuring they are on track to meet their degree requirements.

  3. What information is required on the 104 R form?
    • Name of the student
    • Academic major
    • Academic school
    • Credit hours and GPA
    • Details of courses taken, including the term, year, course title, and achieved grades
  4. Is providing information on the 104 R form mandatory?

    While students may feel that disclosing their information is voluntary, it is important to note that the information is crucial for determining eligibility for acceptance into the ROTC program. Failure to provide this information may adversely affect a student’s participation.

  5. What are the privacy considerations related to the 104 R form?

    The form is subject to the Privacy Act of 1974, which ensures that individuals' information is handled sensitively. This means that the data collected is to be used solely for managing the ROTC program and will not be disclosed without proper authorization.

  6. How does this form affect academic progress?

    Completing the 104 R form allows the student to project their academic plan. It helps identify if they are on track to complete their degree requirements within the required timeframe, which is essential for ROTC scholarship recipients.

  7. What happens if a student does not follow the outlined academic plan?

    If a student deviates from the academic plan submitted, they may risk their standing in the ROTC program. It could lead to complications regarding their eligibility for continuation in the program or for receiving scholarship funds.

  8. Who should sign the 104 R form?

    Both the student and an official from the institution, such as a registrar or credentials examiner, need to sign the form. Additionally, if the student is a part of the ROTC scholarship program, their signature is also required to confirm understanding of the program’s structures.

  9. Can exceptions to the academic plan be made?

    If there are any deviations from the planned courses as listed on the 104 R form, they must be noted on the reverse side of the worksheet. This helps maintain clarity and ensures that all parties are aware of any changes to the academic trajectory.

Common mistakes

Completing the 104 R form accurately is essential for students participating in the Army Senior ROTC program. However, several common mistakes may occur during this process. Understanding these pitfalls can help ensure the form is filled out correctly, which is vital for both eligibility and academic planning.

One frequent error is failing to provide the correct academic major. Many individuals mistakenly enter a major that they are interested in rather than the one officially recognized by their institution. This discrepancy can lead to complications in assessing academic progress.

Another common oversight involves neglecting to include the appropriate CIP code for their major. The Classification of Instructional Programs (CIP) code serves as a unique identifier for academic programs. Without this code, the processing of the form may be stalled, impacting the student's ability to meet program requirements.

Accurate entry of credit hours is crucial, yet students occasionally miscalculate or misunderstand how to count their completed courses. It is imperative that individuals review their transcripts thoroughly to ensure that the total number of credits listed reflects their actual academic standing.

Inclusion of GPA information also poses a challenge. Some may enter their cumulative GPA instead of the current GPA for the term, leading to inconsistencies in the information presented. Clarity in this section is essential for evaluating academic performance.

Not consulting with an academic advisor can result in missing important details. Students often complete the form independently without getting the necessary guidance. This can lead to misunderstandings about required courses or the academic progression standard that must be followed.

Additionally, failing to sign and date the completion section can cause delays in processing the form. Each student must provide their initials and date beside their term to confirm they have received proper counseling. Without these signatures, the form may be deemed incomplete.

Lastly, not reviewing the entire document before submission can lead to overlooked errors. Students should take the time to go through their completed forms thoroughly, ensuring that all information is accurate and up to date. Missing this step could result in significant consequences for their ROTC participation.

Documents used along the form

The 104 R form, formally known as the Planned Academic Program Worksheet, serves a crucial role in managing the academic paths of students involved in the Army Senior ROTC program. Several other documents are commonly used alongside this form to ensure comprehensive management and assessment. Each document supports the processes of evaluation, eligibility, and progression within the program.

  • DA Form 1059: This form is used to document academic evaluation reports of students participating in the Army ROTC program. It provides a formal record of a cadet's performance and progress, contributing to evaluations necessary for future opportunities within military education and promotions.
  • DA Form 5623: Frequently used for the Army ROTC, this form is the Officer Evaluation Report (OER). It assesses the leadership potential and overall performance of cadets. This document is instrumental in making decisions regarding commissioning and future assignments.
  • DA Form 3147: The ROTC Scholarship Application form, DA Form 3147, is an essential document for students seeking financial assistance through scholarships. It collects pertinent information regarding a student’s academic goals, financial needs, and military service commitment.
  • Transcript: A transcript details the academic record of a student, showcasing completed courses, grades, and GPA. This document helps advisors and evaluators assess the academic status of cadets, ensuring they meet eligibility criteria for the ROTC program.

Understanding these additional documents can significantly enhance the experience of students in the Army ROTC program. Together with the 104 R form, they create a framework that supports both academic and military objectives, facilitating the successful journey of cadets toward commissioning in the Army.

Similar forms

  • 1040 Form: Similar to the 104 R form, the 1040 Form collects data to assess eligibility; however, it focuses on individual income tax filing rather than academic program planning.
  • FAFSA (Free Application for Federal Student Aid): Like the 104 R form, the FAFSA gathers personal information to determine eligibility for financial aid in educational programs, ensuring students meet necessary criteria.
  • Degree Audit Report: This document provides a clear outline of courses completed and requirements remaining, similar to the 104 R, which tracks academic progress toward degree completion.
  • Enrollment Verification Form: This form verifies a student’s enrollment status, paralleling the 104 R's role in confirming a student's academic standing within a program.
  • Academic Advising Worksheet: This worksheet assists students in planning their academic journeys, much like the 104 R form, which helps map out a student’s planned academic program.
  • Transfer Credit Evaluation: This evaluation assesses previously completed coursework for compatibility with current program requirements, similar to the 104 R's function of determining acceptable credits for degree progression.

Dos and Don'ts

Completing the 104 R form accurately is essential for ensuring eligibility and managing the Army Senior ROTC program effectively. Here are five things you should and shouldn't do when filling out this form.

  • Do carefully read each section of the form. Understanding the requirements helps prevent mistakes that could delay processing.
  • Do use accurate and up-to-date information. Ensure that your academic major, course numbers, semester dates, and GPA are correct to reflect your current status.
  • Do sign and date the form where indicated. This confirms that you acknowledge the details provided are true and complete.
  • Do consult with a counselor if you have questions. They can assist you in understanding any parts of the form that may be confusing.
  • Do submit the form on time. Adhering to deadlines is critical to avoid any interruptions in your ROTC status.
  • Don't leave any sections blank. Incomplete forms can lead to processing delays or rejection of your application.
  • Don't use correction fluid on the form. If you make a mistake, cross it out clearly and write the correct information next to it.
  • Don't forget to list all necessary courses. Omitting relevant courses could impact your academic progression and ROTC eligibility.
  • Don't ignore the privacy statement. This informs you of how your information will be used and protected.
  • Don't submit your form without reviewing it thoroughly. Double-checking ensures accuracy and completeness.

Misconceptions

  • Misconception 1: The 104 R form is only for students enrolled in military academies.
  • This is incorrect. The 104 R form is applicable to any student participating in the Army Senior ROTC program, regardless of whether they are at a military academy or a civilian institution.

  • Misconception 2: Submitting the 104 R form guarantees scholarship approval.
  • In reality, the form merely provides a planned academic program. Approval for scholarships depends on other criteria, including qualifications and availability of funds.

  • Misconception 3: The information on the 104 R form is not confidential.
  • The data collected is protected under the Privacy Act. It is crucial for students to understand that their information is kept confidential and used only for specific purposes related to the ROTC program.

  • Misconception 4: Completing the 104 R form is optional for ROTC participants.
  • This is not true. The form must be completed as it provides essential data for assessing a student's eligibility and academic progression within the Army ROTC program.

  • Misconception 5: The 104 R form only tracks a student’s current GPA.
  • In fact, the form records various academic metrics, including credit hours completed, courses being taken, and remaining credits needed for graduation.

  • Misconception 6: The 104 R form must be submitted only once during a student’s ROTC tenure.
  • This is a misunderstanding. The form should be updated regularly to reflect any changes in academic status or course enrollment throughout the program.

  • Misconception 7: Advisors are not required to assist in filling out the 104 R form.
  • In truth, it is strongly recommended that students seek guidance from academic advisors to ensure the form is completed accurately and fully, which helps in maintaining compliance with program requirements.

Key takeaways

This document outlines important points for completing and utilizing the 104 R form, which is a Planned Academic Program Worksheet used by the Army Senior ROTC program. Understanding these takeaways can help ensure accurate and effective use of the form.

  • 1. Purpose of the Form: The 104 R form collects essential information necessary for administering the Army Senior ROTC program.
  • 2. Voluntary Information: Providing data on this form is voluntary, but necessary to assess eligibility for continuation in the ROTC program.
  • 3. Academic Program Overview: The form requires students to outline their planned academic program, including major and courses.
  • 4. Credit Hours: Students must report completed and remaining credit hours towards their degree on the form.
  • 5. Grade Point Average: Current and cumulative GPAs are essential metrics on the form, reflecting academic performance.
  • 6. Course Details: Each course must include specific details such as course number, title, and credit hours. Accurate entry is crucial.
  • 7. Review Requirement: A review of the listed courses indicating whether they are required for degree completion is mandatory.
  • 8. Signatures: Both the student and a certified official must sign the form to validate the information provided.
  • 9. Statement of Understanding: Acknowledgment of the structured program and degree requirements must be signed by both the cadet and the professor of military science.
  • 10. Compliance with Regulations: Adhering to the guidelines found in USACC Pam 145-4 is necessary for proper use of the 104 R form.

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