Fill in Your 104 R Template Get Document Here

Fill in Your 104 R Template

The 104 R form, also known as the Planned Academic Program Worksheet, is a crucial document used in the Army Senior ROTC program. It helps students outline their academic plans to ensure they meet the necessary requirements for commissioning into the Army. Completing this form accurately is essential for students to maintain their eligibility in the program, so be sure to fill it out by clicking the button below.

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Key takeaways

Filling out the 104 R form, also known as the Planned Academic Program Worksheet, is an important step for students in the Army Senior ROTC program. Here are some key takeaways to keep in mind:

  • Purpose: The form helps determine if students meet the academic requirements for commissioning in the Army.
  • Voluntary Disclosure: Providing information is voluntary, but it is essential for assessing eligibility in the ROTC program.
  • Student Information: Clearly fill in your name, academic major, and the date of form preparation.
  • Credit Hours: Accurately report the total credit hours required for your degree and how many you have completed.
  • Grade Point Average (GPA): Include your current GPA and cumulative GPA to show your academic progress.
  • Course Details: List all courses taken, including course number, title, credit hours, and grades achieved.
  • Initials and Dates: Students must initial and date each term to confirm they have been counseled about their academic plan.
  • Review Requirement: Indicate if all listed courses are required for degree completion. If not, provide exceptions.
  • Signatures: Ensure both the student and a certifying official, such as a registrar, sign and date the form.
  • Statement of Understanding: This section confirms that the outlined program meets degree requirements and that the student understands the commitment involved.

Understanding these key points will help streamline the process of filling out the 104 R form and ensure that all necessary information is accurately captured. This is crucial for maintaining eligibility and progressing in the ROTC program.

Dos and Don'ts

When filling out the 104 R form, it's important to follow specific guidelines to ensure accuracy and compliance. Here are four key dos and don'ts:

  • Do provide accurate and complete information in all sections, especially your name and academic major.
  • Do check the dates carefully. Ensure the "as of date" reflects the correct date of form preparation.
  • Don't leave any sections blank. If a question does not apply, indicate that it is not applicable instead of skipping it.
  • Don't forget to have the student initial and date beside each term. This confirms that they have been counseled on their academic plan.

Form Overview

Fact Name Description
Form Purpose The 104 R form is used to outline a planned academic program for students in the Army Senior ROTC program.
Governing Authority It is authorized under Title 10, US Code, sections 2101 and 2104.
Privacy Act Compliance This form adheres to the Privacy Act Statement of 1974, ensuring the protection of personal information.
Eligibility Assessment Information provided helps determine a student's eligibility for acceptance or continuance in the ROTC program.
Academic Major Requirement Students must declare their academic major and provide a corresponding CIP code on the form.
Credit Hours Tracking The form includes sections for tracking credit hours, GPA, and academic progression.
Course Information Students must list course details, including course number, title, credit hours, and grades achieved.
Review Requirement Students must confirm that all listed courses are required for degree completion by marking 'YES' or 'NO'.
Signatures Required The form requires signatures from the student, registrar, and professor of military science for validation.

Common mistakes

  1. Incorrect Personal Information: Many individuals fail to accurately fill out their name, academic major, or other personal details. This can lead to confusion and delays in processing. Always double-check for typos or missing information.

  2. Omitting Required Dates: Not including the date of form preparation or other critical dates can result in the form being considered incomplete. Ensure all date fields are filled out correctly.

  3. Inaccurate Credit Hours: Reporting incorrect credit hours or failing to account for transfer credits can misrepresent a student's academic progress. Be meticulous when listing these numbers, as they directly impact eligibility.

  4. Failure to Sign: Neglecting to sign the form or have the necessary parties sign can invalidate the submission. All required signatures must be obtained to ensure the form is processed.

  5. Not Reviewing Course Requirements: Some students overlook the section that requires them to confirm that all listed courses are necessary for their degree completion. This oversight can lead to complications later on. Always verify that the courses listed align with degree requirements.

Similar forms

The 104 R form is similar to the Academic Plan form used by many universities. Both documents serve the purpose of outlining a student's academic trajectory, ensuring that they meet the necessary requirements for graduation. The Academic Plan form typically includes sections for course titles, credit hours, and grades, mirroring the structure found in the 104 R. This alignment helps academic advisors and students track progress toward degree completion effectively.

In addition to these essential documents, it's important to be aware of resources related to workers' compensation, such as the Georgia PDF, which provides necessary information about the WC-200A Georgia form. This form is pivotal for requesting changes in medical treatment during workers' compensation cases, ensuring that employees receive the appropriate care while adhering to state regulations.

Another document that shares similarities with the 104 R is the Degree Audit Report (DAR). The DAR provides a comprehensive overview of a student's completed and remaining coursework, much like the 104 R. It helps students understand what is required for graduation and can highlight any discrepancies in their academic progress. Both documents are essential tools for academic planning and monitoring.

The Course Registration Form is also akin to the 104 R. This form is used by students to register for classes each semester, detailing the courses they plan to take. Like the 104 R, it requires students to list course titles and credit hours. This similarity emphasizes the importance of careful planning and organization in a student's academic journey.

The Transfer Credit Evaluation form shares characteristics with the 104 R as well. It assesses which credits from previous institutions can be applied toward a current degree program. Both documents require detailed information about courses and credit hours, facilitating a clear understanding of a student’s academic standing and progress.

The Student Academic Progress Report is another document that resembles the 104 R. This report tracks a student's academic performance over time, including GPA and completed courses. Similar to the 104 R, it provides a snapshot of where a student stands in relation to their degree requirements, making it a valuable tool for academic advising.

The ROTC Scholarship Application also bears similarities to the 104 R. This application requires students to outline their academic plans and demonstrate their commitment to completing their degree. Both documents are designed to assess eligibility and support students in their academic endeavors, particularly within the ROTC framework.

The Enrollment Verification Form is akin to the 104 R in that it confirms a student's enrollment status and academic progress. This document is often used for financial aid purposes and requires similar information about courses and credit hours. Both forms help ensure that students are on track to meet their educational goals.

The Graduation Application is another document that parallels the 104 R. This application is submitted by students nearing the completion of their degree, requiring them to list completed courses and remaining requirements. Similar to the 104 R, it serves as a final check to ensure that all academic criteria have been met before graduation.

The Academic Probation Notice is also comparable to the 104 R. This notice is issued to students whose academic performance falls below acceptable standards. It outlines the steps necessary for improvement, similar to how the 104 R helps students plan their coursework to maintain eligibility in the ROTC program.

Lastly, the Academic Advising Worksheet is similar to the 104 R in that it assists students in mapping out their academic goals and requirements. This worksheet is often used during advising sessions to ensure that students are aware of their degree requirements, just as the 104 R serves to guide ROTC cadets in their academic planning.

Other PDF Forms

Your Questions, Answered

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 for managing the Army Senior ROTC program. It helps determine if a student meets the necessary requirements for commissioning in the Army. This form is required to ensure that students are on track to complete their academic programs within the established guidelines.

Who needs to fill out the 104 R form?

Students participating in the Army Senior ROTC program must complete the 104 R form. This includes cadets who are applying for commissioning or those who are already enrolled in the program and need to outline their academic plans for the remaining years of study.

What information is required on the form?

The form requires various details, including:

  1. Name of the student
  2. Academic major and CIP code
  3. Academic school and credit hours
  4. Grade point average (GPA)
  5. Course details such as term, year, course number, title, credit hours, and achieved grades
  6. Signatures of the student and certifying officials

This information helps assess the student's academic progress and eligibility for the ROTC program.

What is the significance of the GPA on the form?

The GPA is a critical component of the 104 R form. It reflects the student's academic performance and is used to evaluate their eligibility for continuation in the ROTC program. A minimum GPA may be required to remain in good standing and to qualify for commissioning.

How does this form relate to ROTC scholarships?

If a cadet is a participant in an ROTC scholarship program, the 104 R form outlines the number of semesters the scholarship will cover. This ensures that the student understands their academic commitments and the duration of financial support available to them during their studies.

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

Providing the necessary information on the 104 R form is voluntary; however, failing to do so may affect the student’s eligibility for acceptance or continuation in the Army ROTC program. The information is crucial for assessing whether the student meets the public law requirements.

How often should the 104 R form be updated?

The 104 R form should be updated at least once per academic year or whenever there are significant changes to the student's academic plan. Regular updates ensure that the information remains accurate and reflects the student's progress toward their degree.

What is the review process for the 104 R form?

Once completed, the 104 R form must be reviewed and signed by both the student and a certifying official, such as a registrar or a professor of military science. This review process confirms that the outlined academic plan meets the necessary requirements for degree completion and ROTC participation.

Form 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

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