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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 essential for students seeking commissioning in the Army, as it helps determine their eligibility and academic trajectory. It collects vital information such as the student's name, academic major, and grade point average, along with detailed course information, including titles, credit hours, and grades achieved. By outlining a projected academic plan, the form ensures that students meet the public law requirements for their remaining academic years. Additionally, it emphasizes the importance of voluntary disclosure, which is necessary for assessing a student's continued participation in the ROTC program. Each student must review and initial their academic progress, confirming that they have been counseled on their course selections. Ultimately, the 104 R form serves as a roadmap for cadets, guiding them toward successful completion of their degree while fulfilling the obligations of their ROTC commitment.

Common mistakes

  1. Incorrect Student Name: Failing to provide the full name as it appears on official documents can lead to processing delays.

  2. Missing Academic Major: Not specifying the academic major may result in ineligibility for certain programs.

  3. Improper CIP Code: Entering an incorrect Classification of Instructional Programs (CIP) code can cause issues in tracking educational progress.

  4. Inaccurate Date: Providing the wrong date of form preparation can lead to confusion regarding eligibility timelines.

  5. Omitting Credit Hours: Not listing the total credit hours can result in miscalculations of academic standing.

  6. Grade Point Average Errors: Incorrectly reporting GPA can affect eligibility assessments and academic evaluations.

  7. Failure to Select Semester or Quarter: Not indicating the academic term type may complicate the review process.

  8. Incomplete Course Information: Omitting details such as course number, title, or credit hours can hinder the evaluation of academic progress.

  9. Not Initialing Counseling: Failing to provide initials and dates beside each term indicates that the student has not been counseled, which is a requirement.

  10. Unsigned Forms: Neglecting to sign the form can render it invalid, delaying the application process.

Preview - 104 R Form

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

Documents used along the form

The 104 R form is an essential document for students involved in the Army Senior ROTC program, detailing their academic plans and progress. Alongside this form, several other documents may be required to ensure a comprehensive understanding of a student's academic trajectory and eligibility. Below is a list of commonly used forms and documents that complement the 104 R form.

  • ROTC Scholarship Application: This application is necessary for students seeking financial assistance through ROTC scholarships. It collects personal information, academic history, and extracurricular involvement.
  • Course Registration Form: Students must complete this form to officially enroll in their chosen courses each semester. It typically includes course codes, titles, and the number of credit hours.
  • Academic Transcript: This document provides a detailed record of a student's academic performance, including courses taken, grades earned, and overall GPA. It is often required for scholarship applications and program assessments.
  • Degree Audit Report: This report outlines the specific requirements for a student's degree program. It helps students track their progress and ensures they meet all necessary criteria for graduation.
  • Advisor Approval Form: This form is used to obtain approval from academic advisors for course selections and academic plans. It ensures that students are on track to meet their educational goals.
  • ROTC Participation Agreement: This agreement outlines the expectations and commitments required of students participating in the ROTC program. It serves as a formal acknowledgment of the responsibilities involved.
  • Motorcycle Bill of Sale: This form is essential for the sale and purchase of motorcycles in Texas, providing legal proof of the transaction between buyer and seller. More details can be found at autobillofsaleform.com/motorcycle-bill-of-sale-form/texas-motorcycle-bill-of-sale-form.
  • Financial Aid Application (FAFSA): Completing this application is crucial for students seeking federal financial aid. It assesses the financial needs of students and determines their eligibility for various aid programs.

Understanding and preparing these documents is vital for a smooth transition through the ROTC program. Ensuring that all forms are accurately completed and submitted on time can significantly impact a student's academic journey and future opportunities.

Similar forms

The 104 R form is similar to the Academic Plan Form used by many universities. This document outlines a student's planned courses for their degree program. It includes information about course titles, credit hours, and grades, much like the 104 R. Both forms help ensure students are on track to meet their academic goals and fulfill graduation requirements.

Another comparable document is the Degree Audit Report (DAR). The DAR provides a comprehensive overview of a student's completed and remaining coursework. It helps students see how their current classes apply to their degree requirements. Like the 104 R, the DAR assists in tracking academic progress and confirming that students are meeting necessary criteria for graduation.

The Course Registration Form is also similar. This form is used to enroll students in specific classes for an upcoming term. It includes details about the courses selected, similar to the course information section in the 104 R. Both documents are essential for planning and ensuring that students take the right classes to progress toward their degree.

The Transcript Request Form bears resemblance as well. This document allows students to request their official academic transcripts from the school. It includes a record of completed courses and grades, just as the 104 R does. Both forms serve to document a student’s academic history and progress toward their degree.

The Satisfactory Academic Progress (SAP) Form is another related document. This form assesses whether a student is meeting the academic standards set by their institution. It often requires similar information regarding GPA and credit hours, akin to what is found on the 104 R. Both forms help institutions determine eligibility for financial aid and continued enrollment.

For those interested in the legal implications involved, the Florida Hold Harmless Agreement is crucial in various contractual situations. This form emphasizes an understanding where one party is protected from liability issues arising from another party’s actions. You can find further details and access the form at this important Hold Harmless Agreement resource.

The Transfer Credit Evaluation Form is also similar. This document evaluates and records credits earned at other institutions. It helps students understand how those credits apply to their current degree program. Like the 104 R, it is crucial for ensuring that students can efficiently progress toward graduation.

The Degree Completion Plan is another document that aligns closely with the 104 R. This plan outlines the specific courses a student must take to complete their degree. It includes timelines and requirements, much like the structured academic program presented in the 104 R. Both documents ensure students have a clear path to graduation.

The Enrollment Verification Form is similar in that it confirms a student's enrollment status. This form is often used for financial aid purposes and includes information about the student's academic program. Like the 104 R, it verifies that the student is actively pursuing their degree.

Lastly, the Financial Aid Application Form shares similarities with the 104 R. This form collects information about a student’s academic program and progress, which is necessary for determining eligibility for financial aid. Both documents play a role in ensuring that students can continue their education without financial barriers.

Dos and Don'ts

When filling out the 104 R form, it is essential to be thorough and accurate. Here are some important guidelines to follow and avoid:

  • Do double-check your personal information. Ensure your name, academic major, and other identifying details are correct.
  • Do provide accurate course information. List all courses, credit hours, and grades as they appear in your academic records.
  • Do sign and date the form appropriately. Your signature confirms that you understand the information provided.
  • Do keep a copy of the completed form. Having a record can be helpful for future reference.
  • Don't leave any sections blank. Incomplete forms can lead to processing delays or rejection.
  • Don't provide false information. Misrepresentation can have serious consequences for your ROTC status.
  • Don't forget to consult with your academic advisor. They can provide guidance on filling out the form correctly.
  • Don't ignore deadlines. Submitting the form late may affect your eligibility for the ROTC program.

Key takeaways

Completing the 104 R form is a crucial step for students involved in the Army Senior ROTC program. The following key takeaways will help ensure that the process is understood and executed properly.

  • Understand the Purpose: The 104 R form is designed to provide necessary information for managing students in the Army ROTC program and ensuring compliance with public law requirements.
  • Voluntary Disclosure: While filling out the form is voluntary, providing accurate information is essential for determining eligibility for the ROTC program.
  • Accurate Academic Information: Students must include their name, academic major, and current GPA. This information is vital for assessing academic standing.
  • Course Details: The form requires detailed information about courses, including course numbers, titles, credit hours, and grades achieved. This ensures a comprehensive academic plan.
  • Review Requirements: Students must confirm that all listed courses are required for degree completion. If there are exceptions, they should be noted on the reverse side of the form.
  • Initials and Counseling: Students should initial and date beside each term to indicate they have been counseled on their academic progression and responsibilities.
  • Signatures Required: The form must be signed by both the student and a certifying official from the institution, ensuring that the information is verified and accurate.
  • Timely Submission: It is important to submit the form by the specified deadlines to avoid any disruptions in scholarship funding or academic progression.

By following these guidelines, students can navigate the process of completing the 104 R form with confidence and clarity.

How to Use 104 R

Completing the 104 R form is an important step in ensuring that your academic program aligns with the requirements of the Army Senior ROTC program. This form collects essential information about your academic plans and progress. Below are the steps to fill out the form accurately.

  1. Enter Student Name: Fill in your last name, first name, and middle initial in the designated space.
  2. Academic Major: Specify your major field of study.
  3. CIP Code: Provide the Classification of Instructional Programs (CIP) code for your major.
  4. Date: Write the date you are completing the form in MM/DD/YYYY format.
  5. Academic School: Indicate the name of the academic institution you are attending.
  6. Credit Hours: List the total credit hours required for your degree.
  7. Grade Point Average (GPA): Enter your current GPA and cumulative GPA. Select whether you are on a semester or quarter system.
  8. Identify Your Institution: Check the appropriate box to indicate if you are enrolled in a host school, extension center, or cross-enrolled.
  9. Complete Course Information: For each term, provide the year, course number, course title, credit hours, credits that count toward your degree, and the achieved grades.
  10. Initials and Date: Have the student initial and date beside each term to confirm counseling has occurred.
  11. Review Course Requirements: Indicate whether all listed courses are required for degree completion by selecting 'YES' or 'NO'. If 'NO', list exceptions on the back of the form.
  12. Student Signature: Sign the form and date it.
  13. Registrar Signature: Obtain the signature of the registrar or certifying official and date it.
  14. Statement of Understanding: Ensure that the statement is signed by both the cadet and the professor of military science, along with their respective dates.