Free 104 R PDF Template Open 104 R Editor Here

Free 104 R PDF Template

The 104 R form, known as the Planned Academic Program Worksheet, is essential for students in the Army Senior ROTC program. This form collects necessary information to evaluate a cadet's academic plan and ensure they meet the requirements for commissioning in the Army. Completing this form accurately is crucial for maintaining eligibility in the ROTC program; fill it out by clicking the button below.

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Key takeaways

  • Understand the Purpose: The 104 R form is designed to collect information necessary for managing the Army Senior ROTC program and ensuring compliance with public law.
  • Voluntary Disclosure: Providing information on the form is voluntary but essential for determining eligibility for the ROTC program.
  • Complete Required Sections: Fill in all required fields, including personal details, academic major, and course information.
  • Track Academic Progress: Use the form to project academic plans and confirm that the student meets the requirements for the remaining academic years.
  • Initial Counseling: Students must initial and date beside each term to indicate they have been counseled about their academic progress.
  • Review Course Requirements: Confirm that all listed courses are necessary for degree completion, marking exceptions if applicable.
  • Signatures Required: Obtain necessary signatures from the student and registrar or certifying official to validate the form.

104 R 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

Page 3 of 3

Similar forms

The 104 R form is similar to the Academic Plan form used by many educational institutions. Like the 104 R, the Academic Plan outlines a student's intended course of study, detailing the courses they plan to take in order to fulfill their degree requirements. Both documents serve to ensure that students are on track to meet graduation criteria. They require the student to provide their major, credit hours, and GPA, allowing academic advisors to assist in monitoring progress and making necessary adjustments to the student’s academic trajectory.

Another document that parallels the 104 R form is the Degree Audit Report. This report provides a comprehensive overview of a student’s academic progress towards their degree. Similar to the 104 R, it breaks down completed courses, credits earned, and requirements still needed for graduation. The Degree Audit Report helps students and advisors identify any gaps in coursework, ensuring that students remain informed about their academic standing and can make informed decisions about their future course selections.

The Student Educational Plan is also comparable to the 104 R form. This plan is often created in collaboration with academic advisors and outlines the courses a student will take over their academic career. Both documents emphasize the importance of planning and organization in achieving academic goals. The Student Educational Plan typically includes timelines and milestones, guiding students through their academic journey, much like the structured approach of the 104 R form.

The Asurion F-017-08 MEN form is crucial for anyone navigating consumer protection and warranty-related claims, much like academic documents help students maintain their educational path. To further understand the importance and utility of the Asurion F-017-08 MEN form, you can refer to the detailed guide available at https://templates-guide.com/asurion-f-017-08-men-template.

Lastly, the Course Registration Form shares similarities with the 104 R form. This form is used by students to officially enroll in classes for a given semester. Like the 104 R, it requires students to provide detailed information about the courses they intend to take, ensuring that they meet the necessary prerequisites and degree requirements. Both forms facilitate communication between students and educational institutions, helping to streamline the registration process and maintain academic accountability.

How to Use 104 R

Completing the 104 R form is an essential step in outlining a planned academic program for students involved in the Army Senior ROTC program. This form helps to ensure that the academic path aligns with the necessary requirements for commissioning in the Army. Following the steps below will guide you through the process of filling out this form accurately.

  1. Enter the student's name: Fill in the last name, first name, and middle initial in the designated fields.
  2. Specify the academic major: Write down the major that the student is pursuing.
  3. Provide the CIP code: Enter the Classification of Instructional Programs (CIP) code associated with the academic major.
  4. Indicate the date: Fill in the date the form is being prepared in MM/DD/YYYY format.
  5. List the academic school: Enter the name of the school where the student is enrolled.
  6. Detail credit hours: Input the total number of credit hours required for the degree.
  7. Record the grade point average (GPA): Provide the current GPA, cumulative GPA, and specify whether the student is on a semester or quarter system.
  8. Complete the course information: For each course, fill in the term, year, course number, title, credit hours, credits that count towards the degree, and achieved grades.
  9. Initial and date: Have the student initial and date beside each term to confirm counseling has occurred.
  10. Review course requirements: Indicate whether all listed courses are required for degree completion and note any exceptions if applicable.
  11. Signatures: The student must sign and date the form, followed by the registrar or certifying official's signature and date.

After completing these steps, ensure that all information is accurate and clear. This form will play a crucial role in the student's academic journey within the ROTC program.

Documents used along the form

The 104 R form, known as the Planned Academic Program Worksheet, is essential for students in the Army Senior ROTC program. It provides a structured outline of the academic path that cadets must follow to meet commissioning requirements. Alongside this form, several other documents are commonly used to support a cadet’s academic and administrative needs. Below is a list of these documents, each serving a unique purpose in the overall process.

  • ROTC Scholarship Application: This document is critical for students seeking financial assistance through ROTC scholarships. It collects personal information, academic achievements, and extracurricular activities, helping to determine eligibility and funding levels.
  • Cadet Contract: This agreement outlines the obligations of the cadet to the ROTC program, including service commitments after graduation. It is a binding document that ensures both parties understand their responsibilities.
  • Academic Progress Report: This report tracks a cadet's academic performance, detailing grades and credit hours earned. It is often required to ensure that cadets are on track to meet their degree requirements.
  • Aaa International Driving Permit Application - This essential form is designed for travelers intending to drive abroad, providing a translated version of their driver's license. For more information, visit https://fillable-forms.com/blank-aaa-international-driving-permit-application.
  • Enrollment Verification Form: This form confirms a cadet's enrollment status at their academic institution. It is often used for financial aid purposes and ensures that the ROTC program is aware of the cadet's current academic standing.
  • Degree Audit Report: This document provides a comprehensive overview of the courses a cadet has completed and those remaining for graduation. It helps cadets plan their academic schedules effectively.
  • Service Agreement: This document outlines the terms of service that a cadet agrees to upon commissioning. It specifies the duration and nature of service commitments, ensuring clarity on future obligations.
  • Medical Examination Report: Cadets must undergo a medical examination to ensure they meet health standards required for military service. This report is essential for confirming fitness for duty and participation in ROTC activities.

These documents collectively support the academic and administrative framework necessary for cadets in the ROTC program. Each plays a vital role in ensuring that students are prepared for both their academic pursuits and future military service.

Common mistakes

  1. Failing to include the full name of the student in the correct format (Last, First, MI).

  2. Not providing the academic major or entering an incorrect one.

  3. Omitting the CIP code, which is essential for tracking academic programs.

  4. Incorrectly filling out the AS OF DATE, leading to confusion about the form's validity.

  5. Neglecting to specify the academic school the student is attending.

  6. Miscalculating credit hours or failing to include all relevant courses.

  7. Not providing an accurate grade point average (GPA), which can affect eligibility.

  8. Failing to check the appropriate identification box for the type of enrollment.

  9. Forgetting to have the student initial and date beside each term after counseling.

  10. Not obtaining the necessary signatures from both the student and the registrar.

Dos and Don'ts

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

  • Do provide your full name as it appears on official documents.
  • Don't leave any sections blank; incomplete forms may delay processing.
  • Do use the correct academic major and corresponding CIP code.
  • Don't forget to check the appropriate box for your identification type.
  • Do ensure that all course details, including grades and credit hours, are accurate.
  • Don't misrepresent your GPA or any other academic information.
  • Do have the form reviewed and signed by the appropriate officials before submission.