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Download 104 R Template

The 104 R form is a Planned Academic Program Worksheet used in the Army Senior ROTC program. This form collects essential information to ensure that students meet the academic requirements for commissioning in the Army. It outlines the student's academic plan, detailing coursework, credit hours, and grade point averages, all of which are critical for assessing eligibility and progression in the program.

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Content Overview

The 104 R form, known as the Planned Academic Program Worksheet, plays a crucial role in the Army Senior ROTC program. It is designed to collect essential information from cadets, ensuring they meet the necessary academic requirements for commissioning into the Army. This form requires details such as the student’s name, academic major, and credit hours, along with their grade point average. By outlining a projected academic plan, the form helps determine if the applicant can fulfill the public law requirements for the remaining two years of their academic journey. Additionally, the 104 R form emphasizes the importance of voluntary disclosure, which is vital for assessing a cadet's eligibility for acceptance or continuation in the ROTC program. Each section of the form guides students through a comprehensive review of their academic progress, including course titles, credit hours, and grades achieved. Furthermore, the form necessitates signatures from both the student and the institution's certifying official, underscoring the collaborative nature of the academic planning process. This structured approach not only aids in academic management but also aligns with the overarching goals of the ROTC program, ensuring that cadets are well-prepared for their future roles in the Army.

Key takeaways

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

Understand the Purpose: The form is designed to collect information necessary for managing students and ensuring they meet commissioning requirements.
Voluntary Disclosure: Providing information is voluntary, but it is crucial for determining eligibility for the ROTC program.
Accurate Academic Information: Include accurate details about your academic major, GPA, and credit hours to reflect your current academic status.
Course Tracking: Document all courses taken, including credit hours and grades, to maintain a clear academic record.
Review Requirements: Confirm that all listed courses are required for your degree completion; any exceptions should be noted.
Signatures Matter: Ensure that both the student and the registrar sign the form, as this validates the information provided.
Stay Informed: Familiarize yourself with USACC Pam 145-4 for additional guidance on the form and its requirements.

By following these takeaways, you can effectively complete and utilize the 104 R form to support your academic journey in the ROTC program.

Guide to Writing 104 R

Completing the 104 R form is an essential step for students participating in the Army Senior ROTC program. This form helps outline the academic plan and ensures that students meet the necessary requirements for commissioning. Below are the steps to accurately fill out the form.

Student Information: Enter the student's name (last, first, middle initial) in the designated field.
Academic Major: Fill in the student's academic major.
CIP Code: Provide the Classification of Instructional Programs (CIP) code related to the major.
Date of Form Preparation: Indicate the date the form is being filled out in MM/DD/YYYY format.
Academic School: Specify the name of the academic institution.
Credit Hours: List the total credit hours required for the degree.
Grade Point Average (GPA): Enter the current GPA and cumulative GPA.
Select Semester or Quarter: Check the appropriate box to indicate whether the student is on a semester or quarter system.
Course Information: For each term, fill out the course number, title, credit hours, credits that count toward the degree, and achieved grades. Repeat this for all terms as necessary.
Student Initials & Date: Have the student initial and date beside each term to confirm counseling.
Review: Indicate whether all courses listed are required for degree completion by checking 'YES' or 'NO'. If 'NO', list exceptions on the reverse side of the form.
Student Signature: The student must sign the form to confirm the information provided is accurate.
Date: Enter the date of the student's signature in MM/DD/YYYY format.
Registrar Signature: The registrar or certifying official must sign the form to validate the information.
Registrar Date: Include the date of the registrar's signature in MM/DD/YYYY format.

Once the form is filled out completely, it should be submitted as required by the ROTC program guidelines. Ensure that all information is accurate and that signatures are obtained to avoid any delays in processing.

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Form Preview Example

PLANNED ACADEMIC PROGRAM WORKSHEET

For use of this form, see USACC Pam 145-4, the proponent agency is ATCC-PA-C

DATA REQUIRED BY PRIVACY ACT STATEMENT OF 1974

1.AUTHORITY: Title 10, US Code 2101 and 2104

2.PRINCIPAL PURPOSE(S): To provide information and data necessary for administering the Army Senior ROTC program, processing, and managing of selected students for commissioning in the Army IAW established public law and Army Regulations.

3.ROUTINE USE(S): To provide a projected academic plan to determine if the applicant meets the public law requirements of two remaining academic years.

4.VOLUNTARY DISCLOSURE AND EFFECT ON INDIVIDUAL NOT PROVIDING INFORMATION: Voluntary information is necessary to determine eligibility of the individual for acceptance,

continuance, or discontinuance in the Army ROTC program.

1. NAME OF STUDENT (LAST, FIRST, MI)

2. ACADEMIC MAJOR

2a. CIP CODE

3. AS OF DATE (MM/DD/YYYY) (Date of form preparation)

4. ACADEMIC SCHOOL

5. CREDIT HOURS

6. GRADE POINT AVERAGE (GPA)

Select Semester or Quarter (S/Q)

Semester

Term:

a. IDENTIFICATION (Check one):

Host

Curr GPA:

CUM:

Curr GPA:

CGPA:

Extension Center

a. Total required for degree:

Term:

Cross-Enrolled

(1) ROTC Hours that do not count:

Curr GPA:

CUM:

Curr GPA:

CGPA:

(2) Total Hours Rqd for NAPS:

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:

c. Transfer Credits accepted:

Curr GPA:

CUM:

Curr GPA:

CGPA:

d. Remaining for Degree:

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.

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

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)

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

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:

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:

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, known as the Planned Academic Program Worksheet, plays a crucial role in the Army Senior ROTC program. It ensures that cadets have a structured academic plan that meets the necessary requirements for commissioning. However, this form is often accompanied by several other documents that further support a cadet's academic and military journey. Below is a brief overview of these essential forms.

ROTC Scholarship Application: This document is vital for students seeking financial assistance through the ROTC program. It collects personal information, academic history, and extracurricular activities to determine eligibility for scholarships that can cover tuition and other educational expenses.
Motor Vehicle Bill of Sale: Essential for documenting the sale of a vehicle, this form serves both as a receipt and proof of ownership transfer, detailing the vehicle's condition, price, and specifics, and can be obtained to download the document.
Cadet Command Enrollment Form: This form is necessary for officially enrolling in the ROTC program. It captures essential details such as the cadet's personal information, academic institution, and the specific ROTC unit they will join, ensuring that all administrative processes are correctly followed.
Academic Advising Form: Often used in conjunction with the 104 R form, this document outlines a cadet's academic progress and future course plans. It serves as a guide for both the cadet and academic advisors, helping to ensure that all necessary courses are taken to meet degree requirements.
Service Agreement: This agreement is a commitment between the cadet and the Army, detailing the terms of service after graduation. It outlines the obligations of the cadet, including the length of service and any conditions tied to scholarships or financial assistance received during their time in the ROTC program.

In summary, the 104 R form is just one piece of a larger puzzle that includes various documents essential for cadets in the ROTC program. Each form plays a distinct role in ensuring that students are on track for both their academic and military careers, ultimately leading to successful commissioning in the Army.