Get 104 R Form

Get 104 R Form

The 104 R form, also known as the Planned Academic Program Worksheet, is essential for students participating in the Army Senior ROTC program. This form collects vital information to ensure that students meet the academic requirements necessary for commissioning in the Army. Completing this form accurately is crucial for your eligibility, so be sure to fill it out by clicking the button below.

Structure

The 104 R form serves as a crucial tool for students participating in the Army Senior ROTC program, enabling them to outline their planned academic journey. This form, officially known as the Planned Academic Program Worksheet, captures essential details about the student’s academic major, credit hours, and grade point average (GPA). It is designed to ensure that students meet the necessary public law requirements for their remaining academic years. By documenting course selections, credit allocations, and grades, the form helps students and advisors track academic progress effectively. Additionally, it emphasizes the importance of voluntary disclosure of information, which is vital for determining eligibility and maintaining enrollment in the ROTC program. The completion of this form is not just a bureaucratic step; it represents a commitment to a structured academic path that supports the cadet's future in the Army. With signatures from both the student and an academic official, the 104 R form underscores the collaborative effort between the cadet and the institution to achieve educational and military goals.

104 R Preview

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 Data

Fact Name Description
Authority The 104 R form is governed by Title 10, US Code sections 2101 and 2104.
Purpose This form is used to collect necessary information for administering the Army Senior ROTC program.
Privacy Act Compliance Data collection follows the Privacy Act Statement of 1974 to ensure individuals' privacy rights are protected.
Voluntary Disclosure Providing information is voluntary, but it affects eligibility for acceptance or continuation in the Army ROTC program.

How to Use 104 R

Completing the 104 R form requires careful attention to detail. This form collects essential information for managing the Army Senior ROTC program and assessing eligibility for commissioning in the Army. Follow these steps to ensure accurate completion of the form.

  1. Write the student's full name in the format: Last, First, Middle Initial.
  2. Enter the academic major of the student.
  3. Provide the CIP code related to the academic major.
  4. Fill in the date of form preparation using the MM/DD/YYYY format.
  5. State the name of the academic school.
  6. Indicate the total credit hours required for the degree.
  7. Record the student's current grade point average (GPA) and select whether the academic term is a semester or quarter.
  8. For each term, list the term, year, course number, course title, course credit hours, credits that count towards the academic degree, and achieved grades. Repeat this for all required terms.
  9. Have the student initial and date beside each term to confirm counseling has occurred.
  10. Indicate whether all courses listed are required for degree completion by checking 'YES' or 'NO.' If 'NO,' provide exceptions on the reverse side of the form.
  11. Obtain the student's signature and date.
  12. Get the signature of the registrar or examiner of credentials and the corresponding date.
  13. Complete the statement of understanding, including the full name of the cadet, the name of the university or college, and the type of degree being pursued.
  14. Ensure the cadet and the professor of military science sign and date the statement of understanding.

Key Facts about 104 R

What is the purpose of the 104 R form?

The 104 R form, known as the Planned Academic Program Worksheet, serves to gather essential information for managing the Army Senior ROTC program. It helps determine if a student meets the requirements for commissioning in the Army. The form outlines the academic plan for students, ensuring they are on track to complete their degree within the required timeframe.

Who needs to complete the 104 R form?

Students enrolled in the Army ROTC program are required to complete the 104 R form. This includes cadets who are pursuing their academic degrees while participating in ROTC. The form is particularly important for those who are scholarship recipients, as it helps verify that they are maintaining the necessary academic progress to continue receiving financial support.

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). Additionally, students must list their courses, credit hours, and the grades they have achieved. This information allows the ROTC program to assess the student's academic standing and ensure they are meeting the requirements for their degree.

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

Providing information on the 104 R form is voluntary; however, it is crucial for determining a student's eligibility for acceptance, continuance, or discontinuance in the Army ROTC program. If a student chooses not to provide the necessary information, it may hinder their ability to participate in the program or receive financial assistance through scholarships.

How is the 104 R form submitted and who reviews it?

The completed 104 R form must be submitted to the appropriate ROTC officials at the student's academic institution. After submission, the form is reviewed by the Registrar and the Professor of Military Science, who will ensure that all information is accurate and meets the program's requirements. Their signatures on the form indicate that the student's academic plan has been officially evaluated.

Common mistakes

Filling out the 104 R form can be straightforward, but many people make common mistakes that can lead to complications. One frequent error is not providing complete and accurate information in the NAME OF STUDENT section. Ensure that the last name, first name, and middle initial are filled in correctly. Any discrepancies can cause delays in processing and may affect eligibility.

Another mistake is failing to select the correct ACADEMIC MAJOR and corresponding CIP CODE. It’s important to verify that the major aligns with the degree program. This ensures that the academic plan meets the requirements set by the Army ROTC program. Double-checking this information can save time and prevent issues later.

Many individuals overlook the AS OF DATE field. This date should reflect the moment the form is completed. An incorrect date can lead to confusion regarding the student's current academic status. Always use the correct format (MM/DD/YYYY) to avoid any misunderstandings.

In the course listing section, students often forget to include all relevant courses or miscalculate CREDITS THAT COUNT TOWARDS ACADEMIC DEGREE. Each course should be listed with its corresponding credit hours and grades. Missing or incorrect information here can impact the assessment of academic progress.

Lastly, neglecting to obtain the necessary signatures can halt the processing of the form. Both the student and the certifying official must sign and date the form. Ensure that all signatures are collected before submission to avoid unnecessary delays.

Documents used along the form

The 104 R form, known as the Planned Academic Program Worksheet, is an essential document used in the Army Senior ROTC program. Alongside this form, several other documents and forms are commonly utilized to ensure a comprehensive understanding of a cadet's academic and military obligations. Here is a list of related forms that may be required.

  • Form 104-R Addendum: This addendum provides additional details or clarifications about the academic plan outlined in the 104 R form. It may include changes in course selection or updates on academic progress.
  • Form 105-R: This form is used to report a cadet's academic performance and progress. It includes grades, credit hours earned, and any academic challenges faced by the cadet.
  • Form 106-R: This document is a request for academic leave or withdrawal from the ROTC program. It outlines the reasons for the request and the expected duration of absence.
  • Form 107-R: This form is utilized to apply for scholarships or financial aid within the ROTC program. It requires detailed information about the cadet's financial situation and academic achievements.
  • Form 108-R: This is a declaration of intent to commission, confirming a cadet's commitment to serve in the Army upon graduation. It includes a timeline for commissioning and any additional requirements.
  • Form 109-R: This form is used for documenting any changes in a cadet’s academic major or minor. It ensures that the ROTC program is aware of the cadet's updated educational goals.
  • Form 110-R: This document is a formal request for an academic advisor or counselor meeting. It helps cadets seek guidance on their academic plans and ROTC commitments.
  • Form 111-R: This form is used to report any disciplinary actions or academic probation statuses. It provides a record of the cadet's conduct and academic standing.

Each of these forms plays a critical role in the administration of the ROTC program and the academic success of cadets. Understanding their purpose and requirements can help ensure that cadets remain on track with their educational and military goals.

Similar forms

  • Form 1040: This is the standard individual income tax return form used in the United States. Like the 104 R form, it requires detailed information about the individual's financial situation, including income and expenses, to determine eligibility for certain benefits or programs.
  • Form I-20: Issued to international students, this form outlines the academic program and confirms enrollment in a U.S. educational institution. Similar to the 104 R form, it serves to document the student's planned academic trajectory and compliance with program requirements.
  • FAFSA (Free Application for Federal Student Aid): This form collects information about a student's financial situation to determine eligibility for federal student aid. Both the FAFSA and the 104 R form require personal and academic details to assess eligibility for educational programs.
  • Academic Plan: This document outlines a student's course of study and academic goals. Like the 104 R form, it is used to ensure that students are on track to meet their degree requirements and to facilitate academic advising.
  • Degree Audit Report: This report provides an overview of completed and remaining coursework needed for degree completion. Similar to the 104 R form, it helps students and advisors track academic progress and ensure compliance with graduation requirements.
  • Enrollment Verification Form: This form verifies a student's enrollment status at an institution. It is akin to the 104 R form in that it confirms a student's participation in a specific academic program and is often required for financial aid or other benefits.

Dos and Don'ts

When filling out the 104 R form, attention to detail is crucial. Here are five important dos and don'ts to keep in mind.

  • Do ensure all personal information is accurate, including your full name and academic major.
  • Do double-check the academic year and term dates to avoid any discrepancies.
  • Do list all courses with their respective credit hours and grades clearly.
  • Do have a faculty advisor review your form for completeness and correctness.
  • Do sign and date the form to validate your submission.
  • Don't leave any sections blank; incomplete forms may delay processing.
  • Don't use abbreviations or shorthand that could lead to misunderstandings.
  • Don't forget to include any transfer credits, as they are essential for your degree evaluation.
  • Don't misrepresent your academic progress; honesty is vital in this process.
  • Don't neglect to keep a copy of the completed form for your records.

Misconceptions

Here are some common misconceptions about the 104 R form:

  • It is only for ROTC scholarship recipients. The 104 R form is used by all students in the Army ROTC program, not just those receiving scholarships.
  • It is a one-time requirement. Students must complete this form for each academic term to track their progress and ensure they meet program requirements.
  • It does not affect academic standing. The information on the 104 R form is important for determining a student's eligibility and academic progress within the ROTC program.
  • All courses listed must be completed at the host institution. Students can transfer credits from other institutions, which can also be reflected on the form.
  • The form is only for degree completion. While it helps in degree planning, it also serves to assess eligibility for continued participation in the ROTC program.
  • Students do not need to consult with advisors. It is essential for students to meet with academic advisors to ensure that their planned programs align with their degree requirements.
  • Submitting the form guarantees commissioning. Completing the 104 R form does not automatically lead to commissioning; students must still meet all program requirements.
  • It is not necessary to keep copies of the form. Students should retain copies for their records, as they may need to reference them in the future.

Key takeaways

Understanding the 104 R form is essential 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 a structured academic plan. It helps determine if a student meets the requirements for commissioning in the Army.
  • Information Required: Students must fill out personal details, including their name, academic major, credit hours, and GPA. Accurate information is crucial for processing and managing their ROTC status.
  • Voluntary Disclosure: While providing information is voluntary, it is necessary for assessing eligibility. Not submitting the required data can impact a student's acceptance or continuation in the program.
  • Counseling Confirmation: Students must initial and date beside each term on the form. This indicates they have received counseling regarding their academic progress and course requirements.

By keeping these points in mind, students can navigate the 104 R form more effectively and ensure they meet their academic and ROTC goals.