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The 104 R form, officially known as the Planned Academic Program Worksheet, plays a crucial role in the administration of the Army Senior ROTC program. This form is designed to gather essential information about a cadet's academic trajectory, ensuring compliance with public law and Army regulations. It requires details such as the student's name, academic major, credit hours, and grade point average (GPA). Additionally, it includes a structured outline of courses, their corresponding credit hours, and achieved grades, which collectively demonstrate the student's progress toward degree completion. The form also addresses the necessary disclosures under the Privacy Act, emphasizing the voluntary nature of the information provided and its importance in determining eligibility for continued participation in the ROTC program. By completing the 104 R form, cadets not only affirm their commitment to their academic pursuits but also facilitate the management and processing of their commissioning into the Army.

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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 Specifications

Fact Name Details
Authority This form is governed by Title 10, US Code Sections 2101 and 2104.
Principal Purpose The form collects data necessary for administering the Army Senior ROTC program.
Routine Use It helps create a projected academic plan to assess eligibility for two remaining academic years.
Voluntary Disclosure Providing information is voluntary but essential for determining eligibility in the Army ROTC program.

104 R: Usage Guidelines

Filling out the 104 R form is an important step for students participating in the Army Senior ROTC program. This form collects necessary information about a student's academic plans and progress. It helps determine eligibility for continued participation in the program. Below are the steps to complete the form accurately.

  1. Write the student’s full name in the format: Last, First, MI.
  2. Enter the academic major.
  3. Fill in the date the form is prepared using the format MM/DD/YYYY.
  4. Provide the name of the academic school.
  5. Indicate the total credit hours required for the degree.
  6. List the current grade point average (GPA).
  7. Select whether the academic plan is based on a semester or quarter system.
  8. In the course section, enter the term, year, course number, course title, credit hours, and grades achieved for each course taken.
  9. Have the student initial and date beside each term to confirm they have been counseled.
  10. Review if all listed courses are required for degree completion and indicate YES or NO.
  11. Obtain the student’s signature and the date.
  12. Get the signature of the registrar or certifying official and the date.

Your Questions, Answered

What is the purpose of the 104 R form?

The 104 R form, known as the Planned Academic Program Worksheet, serves to collect essential information for managing the Army Senior ROTC program. It helps determine if a student meets the necessary requirements for commissioning in the Army. By outlining a projected academic plan, the form ensures that students are on track to complete their degree within the stipulated timeframe.

Who needs to fill out the 104 R form?

This form is primarily for students enrolled in the Army ROTC program. It is designed for cadets who are planning their academic coursework to ensure they meet the requirements for their degree. Additionally, it is used by academic advisors and ROTC officials to monitor students’ progress and eligibility for commissioning.

What information is required on the 104 R form?

The form requires various details, including the student’s name, academic major, credit hours, and grade point average (GPA). Students must also list their courses, including course numbers, titles, credit hours, and achieved grades. This comprehensive information helps assess whether the student is meeting the academic standards necessary for their degree.

How does the 104 R form affect a student's ROTC scholarship?

If a cadet is a participant in the ROTC Scholarship program, the 104 R form is crucial. It outlines the number of semesters the scholarship will cover based on the student's planned academic progression. Failure to complete the form accurately may jeopardize the scholarship, as it is linked to the student’s ability to fulfill their degree requirements.

What happens if a student does not provide the requested information?

Providing information on the 104 R form is voluntary, but it is highly recommended. Without this information, the ROTC program may struggle to determine the student’s eligibility for acceptance or continuation. Incomplete forms can lead to delays in processing and may affect a student’s academic and military career.

What should students do after completing the 104 R form?

Once the form is completed, students must sign and date it to confirm they have been counseled about their academic plan. It is also essential for the registrar or an official from the institution to sign and date the form, certifying its accuracy. This ensures that all parties are aware of the student’s academic trajectory and requirements.

Common mistakes

  1. Incomplete Personal Information: Many individuals fail to provide complete personal details. This includes the student's name, academic major, and the date of form preparation. Omitting any of these critical pieces of information can lead to delays in processing.

  2. Incorrect Course Information: Another common error involves inaccuracies in course details. Students often misreport course numbers, titles, or credit hours. Such mistakes can complicate the evaluation of the academic plan and may jeopardize the student’s eligibility for the ROTC program.

  3. Failure to Update Academic Progress: Students sometimes neglect to reflect their current academic status accurately. This includes not updating their GPA or credit hours completed. Keeping this information current is essential for determining eligibility and maintaining satisfactory progress.

  4. Missing Signatures: A frequent oversight is the absence of necessary signatures. Both the student and the certifying official must sign and date the form. Without these signatures, the form is incomplete and cannot be processed.

Documents used along the form

The 104 R form, known as the Planned Academic Program Worksheet, is essential for students participating in the Army Senior ROTC program. To ensure a smooth application process and compliance with educational requirements, several other forms and documents are often used in conjunction with the 104 R form. Below is a list of these documents along with brief descriptions of each.

  • ROTC Scholarship Application: This form is used by students applying for ROTC scholarships. It collects personal information, academic history, and extracurricular activities to assess eligibility.
  • Transcript: An official record from the educational institution that details a student's academic performance, including courses taken and grades earned.
  • Cadet Enrollment Form: This document registers a student into the ROTC program, confirming their participation and commitment to the program's requirements.
  • Medical Examination Report: A form that provides evidence of a student's medical fitness to participate in ROTC activities, ensuring they meet health standards.
  • Financial Aid Application (FAFSA): This federal form determines a student's eligibility for financial aid, including grants and loans, which can support their education while in ROTC.
  • Degree Plan: A detailed outline of the courses a student must complete to earn their degree, often required for academic advising and ensuring ROTC compliance.
  • Course Registration Form: This form is used to officially enroll in specific classes each semester, helping students stay on track for graduation.
  • Student Agreement Form: A document that outlines the responsibilities and commitments of the cadet within the ROTC program, ensuring understanding of program expectations.
  • Parental Consent Form: Required for minors, this form seeks permission from a student's parents or guardians to participate in ROTC activities.

Each of these documents plays a vital role in the administration of the ROTC program and helps ensure that students are adequately prepared for their academic and military commitments. Collectively, they support the overall mission of developing future leaders in the Army.

Similar forms

The 104 R form serves as a Planned Academic Program Worksheet for students in the Army Senior ROTC program. Several other documents share similarities with this form, primarily in their purpose of tracking academic progress and ensuring compliance with educational requirements. Below is a list of eight documents that are comparable to the 104 R form:

  • Academic Plan Form: This document outlines a student's intended course of study, similar to how the 104 R form maps out the academic program for ROTC cadets.
  • Degree Audit Report: This report provides a detailed analysis of a student's completed and remaining coursework, akin to the 104 R's focus on credits required for degree completion.
  • Transcript: A transcript records all courses taken and grades received, paralleling the 104 R's section on course titles and achieved grades.
  • Course Registration Form: This form is used to enroll in classes for a semester, much like the 104 R assists in planning future semesters for ROTC students.
  • Academic Probation Notice: This document alerts students about their academic standing, similar to how the 104 R ensures students meet GPA requirements.
  • Financial Aid Application: This application assesses eligibility for financial support, reflecting the 104 R's role in determining ROTC scholarship eligibility.
  • Student Enrollment Verification: This form verifies a student's enrollment status, much like the 104 R confirms a cadet's participation in the ROTC program.
  • Graduation Application: This application initiates the process of graduating, aligning with the 104 R's aim to ensure that all academic requirements are met before degree conferral.

Dos and Don'ts

When filling out the 104 R form, attention to detail is crucial. Here are four essential dos and don'ts to ensure accuracy and compliance:

  • Do double-check all personal information, such as the student's name and academic major, for accuracy.
  • Do ensure that all required signatures are collected before submission, including the registrar's and the professor of military science's signatures.
  • Don't leave any sections blank. Every part of the form must be completed to avoid delays in processing.
  • Don't submit the form without reviewing the entire document for errors or omissions.

Misconceptions

Misconceptions about the 104 R form can lead to confusion among students and advisors. Here are ten common misunderstandings:

  • It is mandatory for all ROTC students. Many believe that every ROTC student must submit the 104 R form. In reality, it is only required for those who need to outline their academic plans for commissioning.
  • The form guarantees commissioning. Some think that completing the 104 R form automatically ensures they will be commissioned. However, meeting all requirements is necessary for commissioning.
  • All information is optional. There is a misconception that students can leave sections blank. Providing complete and accurate information is crucial for evaluating eligibility.
  • Only academic majors matter. While the academic major is important, the form also requires details about credit hours and GPA, which are equally significant.
  • Students can submit the form at any time. Some believe they can submit the 104 R form whenever they want. It must be submitted by specific deadlines set by the ROTC program.
  • It is only for new students. Many think the form is only for first-year students. In truth, all students must complete it to track their academic progress throughout their ROTC experience.
  • Advisors do not need to review it. Some students assume that they can complete the form independently. Advisors play a critical role in reviewing and approving the plan.
  • Transfer credits do not need to be reported. There is a belief that transfer credits are irrelevant. However, they must be documented as they affect the total credits required for the degree.
  • Grades are not important. Some may think that only course titles and credit hours matter. In fact, achieved grades are essential for assessing academic performance.
  • The form is only for degree completion. While the primary purpose is to track degree requirements, the form also helps in ensuring compliance with ROTC program standards.

Key takeaways

Filling out the 104 R form is a crucial step for students involved in the Army Senior ROTC program. Here are some key takeaways to keep in mind:

  • Purpose of the Form: The 104 R form is designed to provide essential information for administering the Army Senior ROTC program and ensuring students meet academic requirements for commissioning.
  • Voluntary Disclosure: While providing information is voluntary, it is necessary to determine eligibility for acceptance and continuation in the ROTC program.
  • Accurate Information: Ensure that all details, such as name, academic major, and GPA, are filled out accurately. Mistakes can delay processing.
  • Course Details: List all courses taken, including course numbers, titles, credit hours, and grades. This information is vital for assessing academic progress.
  • Initials and Counseling: Students must initial and date beside each term, indicating they have received counseling regarding their academic plan.
  • Review Requirement: Confirm that all listed courses are required for degree completion. If not, exceptions should be noted on the reverse side of the form.
  • Signatures Matter: Both the student and the certifying official must sign and date the form. This ensures that all parties are aware of the academic plan outlined.

Completing the 104 R form accurately and thoroughly will help streamline the process of managing your academic program and ensure you remain on track for commissioning. Take your time, review your entries, and seek assistance if needed.