Free 104 R PDF Form

Free 104 R PDF Form

The 104 R form is a Planned Academic Program Worksheet used within the Army Senior ROTC program. This essential document helps students outline their academic plans, ensuring they meet the necessary requirements for commissioning in the Army. By providing detailed information about courses and academic progress, the form plays a crucial role in guiding cadets toward successful completion of their degrees.

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The 104 R form, known as the Planned Academic Program Worksheet, serves a critical role in the administration of the Army Senior ROTC program. This form is designed to collect essential information from students, ensuring that they meet the necessary requirements for commissioning in the Army. It includes data such as the student's name, academic major, and grade point average, alongside a detailed academic plan that outlines the courses taken and those remaining for degree completion. The information gathered helps determine eligibility for continued participation in the ROTC program, as well as compliance with public law mandates regarding academic progression. The form also emphasizes the importance of voluntary disclosure, indicating that while providing information is not mandatory, it is crucial for assessing a student's standing within the program. Students must indicate their academic progress through various terms, documenting course titles, credit hours, and grades achieved. Additionally, the form requires signatures from both the student and institutional officials, affirming the accuracy of the academic plan presented. This structured approach not only aids in tracking academic performance but also aligns with the Army's regulatory framework, ensuring that all participants remain on track for successful commissioning.

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

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. Several other documents often accompany this form to ensure comprehensive processing and management of students. Below is a list of these commonly used forms and documents.

  • USACC Form 105-R: This form serves as a contract for ROTC scholarship recipients. It outlines the terms and conditions of the scholarship, including service obligations and financial responsibilities.
  • USACC Form 106-R: This document is a performance evaluation form. It assesses the cadet's progress in the ROTC program and provides feedback on their academic and leadership development.
  • Mobile Home Bill of Sale: This document facilitates the transfer of ownership of a mobile home, serving as proof of transaction and outlining key details about the buyer and seller. For more information, visit https://parkhomebillofsale.com/free-washington-mobile-home-bill-of-sale/.
  • USACC Form 107-R: The Academic Performance Report is used to track a cadet's academic achievements. It includes GPA information and course completion status, ensuring that the cadet meets the necessary academic standards.
  • USACC Form 108-R: This form is a request for exceptions or waivers. Cadets may use it to formally request adjustments to their academic program or ROTC requirements due to extenuating circumstances.

These forms collectively support the administration of the ROTC program and help maintain the academic integrity and performance standards required for commissioning in the Army. Proper completion and submission of all related documents are crucial for cadets to achieve their educational and military goals.

Key takeaways

  • Understand the Purpose: The 104 R form is designed to provide essential information for managing students in the Army Senior ROTC program. It helps determine eligibility for commissioning in the Army.
  • Voluntary Disclosure: While providing information is voluntary, it is crucial for assessing your eligibility for the ROTC program. Without this information, your application may be incomplete.
  • Accurate Information: Ensure that all personal details, such as your name and academic major, are filled out accurately. Any discrepancies could lead to delays in processing your application.
  • Course Information: List all courses you plan to take, including course numbers, titles, credit hours, and grades. This information is vital for evaluating your academic progress.
  • Initials and Counseling: You must initial and date beside each term to indicate that you have received counseling. This step is important for tracking your academic journey.
  • Review Requirements: Confirm that all listed courses are required for your degree completion. If any courses are not required, note exceptions on the reverse side of the form.
  • Signatures Needed: Both the student and a certifying official, such as a registrar or professor, must sign the form. This ensures that your academic plan is officially recognized.
  • Keep a Copy: After completing the form, make sure to keep a copy for your records. This will be helpful for future reference and tracking your academic progress.

Form Overview

Fact Name Details
Purpose The 104 R form is designed to collect information necessary for managing the Army Senior ROTC program and ensuring students meet commissioning requirements.
Authority This form is authorized under Title 10 of the U.S. Code, specifically sections 2101 and 2104.
Privacy Act Compliance It adheres to the Privacy Act Statement of 1974, ensuring that personal data is handled with care.
Voluntary Disclosure Providing information on this form is voluntary, but it is essential for determining eligibility in the Army ROTC program.
Academic Requirements The form outlines the academic plan, including credit hours and GPA, to ensure students meet public law requirements for their degree.
Course Tracking It includes a detailed section for tracking courses taken, credit hours earned, and grades achieved, which are crucial for academic progression.
Review Process Students must confirm that all listed courses are required for their degree completion, facilitating a structured academic pathway.

Frequently Asked Questions

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

    The 104 R form, also known as the Planned Academic Program Worksheet, serves to collect essential information about a student's academic plan. It is primarily used in the Army Senior ROTC program to determine eligibility for commissioning in the Army, based on public law requirements.

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

    This form is required for students participating in the Army ROTC program. It is particularly important for those who are nearing the completion of their academic programs and need to demonstrate that they meet the necessary academic requirements for commissioning.

  3. What information is required on the form?

    The form requires several key pieces of information, including:

    • Name of the student
    • Academic major and CIP code
    • Current GPA and credit hours
    • Details about courses taken, including course titles, credit hours, and grades
    • Projected academic plan for remaining terms
  4. How does the form impact a student's eligibility for ROTC?

    The information provided on the 104 R form helps determine whether a student meets the eligibility criteria for acceptance, continuance, or discontinuance in the ROTC program. It outlines the academic path that must be followed to ensure successful commissioning.

  5. What happens if a student does not provide the required information?

    Failure to provide the necessary information can lead to complications in the student's ROTC status. Without a completed form, the Army may not be able to assess the student's eligibility for commissioning, which could jeopardize their participation in the program.

  6. Is filling out the 104 R form mandatory?

    Yes, completing the 104 R form is mandatory for students in the ROTC program. It ensures that all students are following a structured academic program that aligns with the requirements for commissioning.

  7. What is the significance of the statement of understanding section?

    The statement of understanding confirms that the student and the certifying official acknowledge the academic program outlined in the worksheet. It emphasizes the importance of the degree requirements and the necessity of completing the remaining credit hours for graduation.

  8. How often should the 104 R form be updated?

    The form should be updated at least once per academic term or whenever there is a significant change in the student's academic plan. Regular updates ensure that the information remains accurate and reflects the student's current status.

  9. Who signs the 104 R form?

    The form requires signatures from both the student and the certifying official, typically the registrar or an examiner of credentials. These signatures validate the information provided and confirm the student's understanding of their academic program.

  10. What should a student do if they have questions about the form?

    If a student has questions about the 104 R form, they should reach out to their academic advisor or the ROTC program office. These resources can provide guidance and clarification on how to accurately complete the form.

Misconceptions

Understanding the 104 R form can be challenging. Here are ten common misconceptions about it:

  1. The 104 R form is only for ROTC students. This form is primarily used by students in the Army Senior ROTC program, but it can apply to other programs that require academic planning.
  2. Filling out the 104 R form guarantees acceptance into the ROTC program. Completing the form does not automatically secure a spot. Eligibility is determined by various factors beyond just this form.
  3. Only the student needs to sign the 104 R form. The form requires signatures from both the student and the registrar or certifying official to be valid.
  4. The form is not important for academic planning. In fact, it is crucial for outlining the academic path and ensuring that students meet degree requirements.
  5. The 104 R form is a one-time requirement. Students may need to update and resubmit the form if their academic plans change.
  6. The GPA listed on the form is the only measure of academic success. While GPA is important, the form also considers credit hours and course completion.
  7. All courses listed on the form will count towards the degree. Not all courses may be accepted for credit, depending on the institution's policies.
  8. The 104 R form is only for students with a clear academic path. It can also help students who are still determining their major or course load.
  9. The form is filled out once and forgotten. Regular review and updates are necessary to ensure continued compliance with academic requirements.
  10. Submitting the 104 R form is the end of the process. Students must continue to engage with academic advisors to stay on track for graduation.