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The 104 R form, known as the Planned Academic Program Worksheet, plays a crucial role in the Army Senior ROTC program. It serves as a comprehensive tool for students aiming to become commissioned officers in the Army. This form gathers essential information about the student's academic trajectory, including their major, credit hours, and grade point average. It helps determine whether the student meets the public law requirements for their remaining academic years. The form also outlines the courses the student plans to take, ensuring that these align with degree requirements. Additionally, it includes a statement of understanding, where both the student and the institution acknowledge the structured academic plan. This collaborative approach is vital for maintaining eligibility in the ROTC program and facilitating the student's path toward graduation. The 104 R form is not just a bureaucratic necessity; it is a roadmap that guides students through their educational journey while fulfilling the obligations of their ROTC commitments.

Key takeaways

Here are some key takeaways about filling out and using the 104 R form:

  • Understand the Purpose: The form is designed to outline a student's academic program, ensuring it meets the requirements for the Army Senior ROTC program.
  • Provide Accurate Information: Fill in all required fields, including your name, academic major, and school details, to ensure proper processing.
  • Check the Dates: Make sure to use the correct date format (MM/DD/YYYY) when entering the date of form preparation.
  • List Courses Clearly: When entering courses, include the term, year, course number, title, credit hours, and grades achieved.
  • Initial and Date: Students must initial and date beside each term to confirm they have been counseled about their academic plan.
  • Review Requirements: Ensure that all listed courses are required for your degree completion. If any are not, note exceptions on the reverse side.
  • Signatures Matter: Obtain necessary signatures from both the student and the registrar or certifying official to validate the form.
  • Keep a Copy: Always keep a copy of the completed form for your records, as it may be needed for future reference or verification.

Dos and Don'ts

When filling out the 104 R form, it is important to follow specific guidelines to ensure accuracy and compliance. Below is a list of recommended actions and pitfalls to avoid.

  • Do provide your full name, including last name, first name, and middle initial.
  • Do ensure that your academic major and CIP code are accurately filled in.
  • Do list all relevant course information, including term, year, course number, and title.
  • Do verify your grade point average (GPA) and credit hours before submission.
  • Don't leave any sections blank; all required fields must be completed.
  • Don't forget to initial and date beside each term to confirm counseling.
  • Don't submit the form without reviewing it for errors or omissions.
  • Don't disregard the privacy act statement; understand how your information will be used.

Documents used along the form

The 104 R form is a crucial document for students participating in the Army Senior ROTC program. It outlines the planned academic program and is essential for ensuring that students meet the necessary requirements for commissioning. Alongside the 104 R form, several other documents are often required to complete the application and enrollment process. Below is a list of these forms and documents, along with a brief description of each.

  • Transcript: This document provides a comprehensive record of a student's academic performance, including courses taken, grades received, and credits earned. It is essential for verifying eligibility and academic progress.
  • ROTC Scholarship Application: This application is necessary for students seeking financial assistance through ROTC scholarships. It includes personal information, academic history, and a statement of purpose.
  • Medical Examination Report (DD Form 2808): A medical examination is required to ensure that the student meets the physical and health standards necessary for military service. This report documents the results of the examination.
  • Physical Fitness Assessment (PFA) Results: Students must demonstrate their physical fitness through a series of exercises. The results of this assessment are recorded to ensure compliance with ROTC standards.
  • Classic Vehicle Registration Form: The Texas VTR-850 form is an essential document for vehicle owners seeking to obtain classic license plates in Texas. For more details, visit texasformspdf.com/fillable-texas-vtr-850-online/.
  • Enrollment Agreement: This document outlines the terms and conditions of the student's participation in the ROTC program. It includes commitments regarding service obligations and academic performance.
  • Personal Statement: A personal statement allows students to express their motivations for joining the ROTC program and their future aspirations within the military. This document can be influential in the selection process.
  • Financial Aid Documentation: For students seeking financial support, this documentation includes information about family income, existing financial aid, and any scholarships received. It helps determine eligibility for additional support.
  • Course Registration Forms: These forms are necessary for enrolling in specific courses that are part of the ROTC curriculum. They help ensure that students are on track to meet their academic requirements.
  • Character Reference Letters: Letters from teachers, employers, or community leaders can provide insight into a student's character and leadership potential. These references are often required as part of the application process.

Understanding the various documents required alongside the 104 R form can help streamline the application process for prospective ROTC cadets. Each form plays a vital role in ensuring that students are prepared for the challenges ahead and can successfully navigate their academic and military careers.

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Things to Know About This Form

What is the purpose of the 104 R form?

The 104 R form is designed to provide essential information for managing the Army Senior ROTC program. It helps determine whether students meet the requirements for commissioning in the Army. This form outlines a projected academic plan, ensuring that applicants have the necessary two remaining academic years to complete their degree.

Who needs to fill out the 104 R form?

This form must be completed by students enrolled in the Army ROTC program. It is particularly important for those who are nearing the completion of their academic programs and need to demonstrate their eligibility for continuation or acceptance into the program. The information provided will be used to assess their academic progress and compliance with ROTC requirements.

What information is required on the 104 R form?

The form requires various details, including:

  • Name of the student (last, first, middle initial)
  • Academic major and associated CIP code
  • Credit hours completed and grade point average (GPA)
  • Details of courses taken, including term, year, course number, course title, credit hours, and grades achieved
  • Signatures of the student and certifying official

Completing all sections accurately is crucial for the evaluation process.

What happens if I do not provide the requested information?

Providing the information on the 104 R form is voluntary, but it is necessary for determining eligibility for the Army ROTC program. If you choose not to provide the required information, it may affect your acceptance, continuance, or ability to complete the program. Therefore, it is advisable to fill out the form completely and accurately to avoid any issues with your academic standing or ROTC participation.

Preview - 104 R Form

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

Document Specifics

Fact Name Details
Form Title Planned Academic Program Worksheet
Governing Law Title 10, US Code 2101 and 2104
Purpose To collect necessary information for administering the Army Senior ROTC program and managing student commissioning.
Privacy Act Compliance This form is used in accordance with the Privacy Act Statement of 1974.
Voluntary Disclosure Providing information is voluntary but crucial for determining eligibility in the Army ROTC program.
Student Counseling Students must initial and date the form to confirm they have been counseled regarding their academic plan.

How to Fill Out 104 R

Completing the 104 R form is an essential step for students involved in the Army Senior ROTC program. This form collects important information about your academic plans and progress. Follow the steps below to fill out the form accurately.

  1. Provide Your Name: Enter your last name, first name, and middle initial in the designated field.
  2. Academic Major: Write down your major.
  3. CIP Code: Fill in the Classification of Instructional Programs (CIP) code that corresponds to your major.
  4. Date: Indicate the date you are filling out the form in MM/DD/YYYY format.
  5. Academic School: Enter the name of your academic institution.
  6. Credit Hours: Specify the total credit hours required for your degree.
  7. Grade Point Average (GPA): Provide your current GPA and cumulative GPA.
  8. Select Semester or Quarter: Check the appropriate box for your academic schedule.
  9. Course Information: For each course, fill in the term, year, course number, title, credit hours, and grades achieved.
  10. Student Initials & Date: Initial and date each term to confirm counseling.
  11. Review: Confirm whether all listed courses are required for your degree completion and indicate if exceptions exist.
  12. Signature of Student: Sign the form to validate your information.
  13. Date: Enter the date of your signature in MM/DD/YYYY format.
  14. Signature of Registrar: Have the registrar or certifying official sign the form.
  15. Date: The certifying official should also date their signature in MM/DD/YYYY format.

After completing the form, ensure all sections are filled out correctly. Submit the form to the appropriate office as instructed. This process will help maintain your eligibility in the ROTC program and ensure you meet the necessary academic requirements.