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.
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.
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:
CGPA:
Extension Center
a. Total required for degree:
1
Cross-Enrolled
(1) ROTC Hours that do not count:
(2) Total Hours Rqd for NAPS:
b. HOST SCHOOL
c. HOST FICE
Normal Academic Progression Standard
b. Credits toward degree Comp to date:
c. Transfer Credits accepted:
d. Remaining for Degree:
e. Number of authorized S/Qs:
7.TERM, YEAR, COURSE NUMBER, COURSE TITLE, COURSE CREDIT HOURS, CREDITS THAT COUNT TOWARDS ACADEMIC DEGREE, AND ACHIEVED GRADES.
a.
Year:
No.
Course Title
Hrs. Cts. Grd.
Total Term Hours:
d.
b.
e.
c.
f.
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
7.TERM, YEAR, COURSE NUMBER, COURSE TITLE, COURSE CREDIT HOURS, CREDITS THAT COUNT TOWARDS ACADEMIC DEGREE, AND ACHIEVED GRADES. (CONTINUED)
g.
h.
i.
j.
k.
l.
m.
n.
o.
Hrs.
Cts.
Grd.
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.
Page 2 of 3
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)
(PROFESSOR OF MILITARY SCIENCE SIGNATURE)
Page 3 of 3
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.
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.
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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.
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.
The form requires several key pieces of information, including:
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.
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.
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.
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.
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.
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.
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.
Understanding the 104 R form can be challenging. Here are ten common misconceptions about it: