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Official 104 R Form in PDF

The 104 R form is a Planned Academic Program Worksheet used in the Army Senior ROTC program. This form collects vital information to assess a student's eligibility for commissioning in the Army. It helps ensure that the academic plans align with public law requirements for the remaining years of study.

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The 104 R form, officially known as the Planned Academic Program Worksheet, serves a crucial role in the administration of the Army Senior ROTC program. Designed for use by students participating in the ROTC, this form collects essential information that helps determine a cadet's eligibility for commissioning in the Army. It requires students to outline their academic plans, ensuring they meet the public law requirements for the remaining two years of their academic journey. The form includes sections for personal details, such as the student’s name and academic major, as well as specific academic data, including credit hours, grade point averages, and course details. Additionally, it provides a structured way for students to document their progress and plan future coursework. This worksheet not only aids in managing the cadet's educational pathway but also ensures compliance with established Army regulations and public law. Understanding the components and purpose of the 104 R form is vital for any cadet aiming to navigate their academic and military commitments successfully.

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Steps to Using 104 R

Completing the 104 R form is an essential step for students involved in the Army Senior ROTC program. This form helps outline the academic plan and ensures that students meet the necessary requirements for commissioning. Follow these steps to accurately fill out the form.

Student Information: Enter the student's name (last, first, middle initial) in the designated space.
Academic Major: Specify the student's major and include the corresponding CIP code.
Date of Form Preparation: Fill in the date using the MM/DD/YYYY format.
Academic School: Indicate the name of the school the student is attending.
Credit Hours: Enter the total number of credit hours required for the degree.
Grade Point Average (GPA): Provide the current GPA, including cumulative GPA if applicable.
Academic Progression: Check the appropriate identification box for the type of school (Host, Extension Center, Cross-Enrolled).
Course Information: For each term, list the year, course number, course title, credit hours, and achieved grades. Make sure to total the hours for each term.
Student Initials & Date: Have the student initial and date next to each term to confirm they have been counseled.
Review: Indicate whether all listed courses are required for degree completion by selecting "YES" or "NO." If "NO," provide exceptions on the reverse side.
Student Signature: The student must sign and date the form.
Registrar Signature: An official from the institution must sign and date the form to certify the information provided.
Statement of Understanding: Both the cadet and the Professor of Military Science must sign and date this statement confirming the program details.

Key takeaways

Filling out and using the 104 R form is essential for students in the Army Senior ROTC program. Here are five key takeaways regarding this process:

Purpose of the Form: The 104 R form serves to provide a structured academic plan, ensuring that students meet the necessary requirements for commissioning in the Army.
Voluntary Disclosure: While providing information is voluntary, it is crucial for determining eligibility for acceptance and continuation in the ROTC program.
Accurate Course Information: Students must accurately list their courses, including credit hours and grades, to reflect their academic progress toward their degree.
Signatures Required: The form requires signatures from both the student and the registrar or certifying official, confirming the accuracy of the information provided.
Review Process: Students must review their course requirements to ensure all necessary courses are included, as this will impact their degree completion timeline.

Misconceptions

Misconceptions about the 104 R form can lead to confusion and mismanagement of academic programs within the Army ROTC. Below are some common misunderstandings and clarifications regarding this important document.

Misconception 1: The 104 R form is only for new ROTC cadets.

This is incorrect. The form is utilized by all cadets to outline their academic plans, regardless of when they joined the program.

Misconception 2: Completing the 104 R form guarantees a scholarship.

While the form is necessary for processing, it does not automatically secure a scholarship. Eligibility and availability of funds are separate considerations.

Misconception 3: The form does not need to be updated once submitted.

In reality, cadets must update the form regularly to reflect any changes in their academic status or course selections.

Misconception 4: Only academic performance is considered in the approval of the 104 R form.

In addition to academic performance, the form also assesses the overall eligibility of cadets based on ROTC requirements and program standards.

Misconception 5: The 104 R form is a one-time requirement.

This form is not a one-time requirement. It must be completed and submitted for each academic term to ensure continued compliance with ROTC standards.

Misconception 6: The 104 R form can be filled out by anyone.

Only the cadet, in conjunction with their academic advisor or military science professor, should complete the form to ensure accuracy and compliance with program requirements.

Misconception 7: The 104 R form is solely for administrative purposes.

While it serves administrative functions, the form also plays a critical role in guiding cadets toward successful completion of their degree programs.

Misconception 8: Once signed, the 104 R form cannot be changed.

Changes can be made to the form after it has been signed, but such modifications must be documented and approved to maintain compliance with ROTC policies.

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:

a. IDENTIFICATION (Check one):

Host

Curr GPA:

CUM:

Curr GPA:

CGPA:

Extension Center

a. Total required for degree:

Term:

Cross-Enrolled

(1) ROTC Hours that do not count:

Curr GPA:

CUM:

Curr GPA:

CGPA:

(2) Total Hours Rqd for NAPS:

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:

c. Transfer Credits accepted:

Curr GPA:

CUM:

Curr GPA:

CGPA:

d. Remaining for Degree:

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.

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

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)

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

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:

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:

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 Specs

Fact Name	Details
Purpose of the Form	The 104 R form is designed to collect essential information for managing the Army Senior ROTC program. It helps in assessing whether students meet the requirements for commissioning in the Army.
Legal Authority	This form operates under Title 10 of the United States Code, specifically sections 2101 and 2104, which outline the legal framework for ROTC programs.
Privacy Act Compliance	In accordance with the Privacy Act of 1974, the form requires voluntary disclosure of information to determine eligibility for the Army ROTC program. Non-disclosure may affect an individual's acceptance or continuation in the program.
Academic Requirements	The form necessitates that students provide a detailed academic plan, ensuring they have two remaining academic years to fulfill public law requirements. This includes tracking credit hours and grade point averages.