Fill Your 104 R Template

Fill Your 104 R Template

The 104 R form is a Planned Academic Program Worksheet utilized within the Army Senior ROTC program. This form collects essential information to ensure that selected students meet the academic requirements necessary for commissioning in the Army. Completing this form accurately is vital for a successful academic journey, so please take a moment to fill it out by clicking the button below.

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The 104 R form serves as a critical tool within the Army Senior ROTC program, guiding students through their academic journey as they prepare for commissioning into the Army. This Planned Academic Program Worksheet collects essential information that helps both students and administrators ensure compliance with public law and Army regulations. It outlines the requirements for the remaining academic years, thereby assisting in the evaluation of a cadet’s eligibility for continued participation in the ROTC program. The form includes sections for personal details, such as the student’s name and academic major, along with academic performance metrics like credit hours and grade point averages. Additionally, it requires a detailed account of courses taken, including course titles, credit hours, and grades achieved, enabling a comprehensive overview of the student’s academic progress. The inclusion of a statement of understanding further emphasizes the structured nature of the program, confirming that the outlined academic plan is designed to meet degree requirements. By gathering this information, the 104 R form plays a vital role in facilitating the successful transition of cadets from academic life to military service.

Documents used along the form

The 104 R form, known as the Planned Academic Program Worksheet, is essential for students participating in the Army Senior ROTC program. It provides a structured overview of the academic plan necessary for commissioning in the Army. Alongside this form, several other documents are commonly utilized to ensure a comprehensive understanding of a student's academic trajectory and ROTC requirements. Below is a list of documents that may accompany the 104 R form.

  • ROTC Scholarship Application: This document is used by students applying for ROTC scholarships. It collects personal information, academic achievements, and extracurricular activities to assess eligibility for financial support.
  • Academic Transcript: An official record of a student's academic performance, including courses taken, grades received, and overall GPA. It is crucial for evaluating progress and compliance with ROTC requirements.
  • Last Will and Testament: Preparing a Last Will is essential for establishing how an individual’s assets will be distributed after their passing, providing clarity and support to their loved ones during a difficult time.
  • Enrollment Verification Form: This form confirms a student's enrollment status at their academic institution. It is often required for scholarship processing and to ensure the student is actively pursuing their degree.
  • Degree Plan: A detailed outline of the courses a student must complete to earn their degree. This document helps both the student and ROTC advisors track academic progress and course requirements.
  • Course Registration Form: This form is used to officially register for classes each semester. It is necessary for maintaining an updated academic schedule that aligns with ROTC commitments.
  • Cadet Commander's Counseling Statement: A written record of counseling sessions between a cadet and their commanding officer. It addresses academic performance, career goals, and ROTC participation, providing guidance for future development.
  • Medical Examination Report: This document outlines the results of a physical examination required for ROTC participation. It ensures that cadets meet the health standards necessary for military service.
  • Financial Aid Award Letter: This letter details the financial aid a student is eligible to receive, including grants, loans, and scholarships. It is important for understanding the financial aspects of attending college while in the ROTC program.
  • ROTC Contract: A binding agreement between the cadet and the ROTC program that outlines the terms of participation, including service commitments and scholarship obligations.

These documents collectively support the administrative processes of the ROTC program and help ensure that students are on track to meet their academic and military obligations. Maintaining accurate records and documentation is essential for both the cadets and the program's success.

Document Preview Example

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

Guidelines on 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 gathers necessary information about a student's academic plans, which helps in assessing their eligibility for the program. Follow these steps to fill out the form accurately.

  1. Student Information: In the first section, provide the student's name in the format of last name, first name, and middle initial.
  2. Academic Major: Enter the student's academic major and the corresponding CIP code.
  3. Date: Fill in the date of form preparation using the MM/DD/YYYY format.
  4. Academic School: Indicate the name of the academic institution the student is attending.
  5. Credit Hours: List the total credit hours required for the degree.
  6. Grade Point Average (GPA): Provide the current GPA and cumulative GPA, checking whether the student is on a semester or quarter system.
  7. Course Information: For each term, record the term, year, course number, course title, credit hours, credits that count toward the degree, and the achieved grades. Repeat this for all terms as necessary.
  8. Student Initials: Have the student initial and date beside each term to confirm they have been counseled.
  9. Review Section: Indicate whether all listed courses are required for degree completion by selecting 'YES' or 'NO.' If 'NO,' note exceptions on the back of the form.
  10. Signatures: The student must sign and date the form. Then, the registrar or certifying official should also sign and date it.
  11. Statement of Understanding: Ensure that the student and the professor of military science sign the statement of understanding on the reverse side, confirming the outlined program meets degree requirements.

Similar forms

The 104 R form is similar to the Academic Plan form, which is used by students to outline their intended courses and track their progress toward graduation. Both documents require students to list their academic major, course titles, credit hours, and grades. The Academic Plan form also serves to ensure that students meet their degree requirements, much like the 104 R form does for ROTC participants.

Another comparable document is the Degree Audit Report. This report provides a comprehensive overview of a student's academic progress, including completed courses, credits earned, and remaining requirements. Like the 104 R form, it helps students and advisors identify what courses are still needed to achieve graduation. Both documents emphasize accountability in a student's educational journey.

The Enrollment Verification form is also similar, as it confirms a student's enrollment status at an institution. This form, like the 104 R, is often used to verify eligibility for programs, scholarships, and other opportunities. Both documents serve as official records that provide essential information about a student's academic standing.

The Course Registration form is another related document. It allows students to officially register for classes each term, requiring similar information about courses, credit hours, and academic goals. Both forms play a crucial role in a student's academic planning and progression through their degree program.

The Transfer Credit Evaluation form is comparable as well. This document assesses and records any credits a student may receive from other institutions. Like the 104 R form, it helps students understand how their previous coursework fits into their current academic program and what additional requirements remain for graduation.

The Satisfactory Academic Progress (SAP) form is similar in purpose, as it monitors a student's academic performance and eligibility for financial aid. Both the SAP and the 104 R forms require students to track their grades and course completion, ensuring they remain on track to meet academic standards.

The Graduation Application form is another document that parallels the 104 R form. It is submitted by students to formally request graduation, requiring them to confirm that all degree requirements have been met. Both forms necessitate a detailed review of a student's academic history to ensure all criteria are fulfilled before graduation.

To facilitate the ownership transfer process, it is crucial to utilize a proper form, such as the essential Motor Vehicle Bill of Sale template available here. This document captures all necessary details regarding the transaction, ensuring clarity and legality in the transfer of a vehicle.

The Financial Aid Application is also relevant. This document gathers information about a student's financial situation and academic status to determine eligibility for financial assistance. Like the 104 R form, it requires students to provide detailed information about their courses and academic progress.

Lastly, the Student Progress Report serves a similar function. It is used to track a student's academic performance over time, including grades and completed courses. Both the Student Progress Report and the 104 R form help students and advisors monitor academic success and make informed decisions about future coursework.

Consider Common Documents

Misconceptions

  • Misconception 1: The 104 R form is only for students in the ROTC program.
  • This form is primarily used by Army Senior ROTC students, but it can also serve as a valuable tool for academic advisors and registrars in other programs to track academic progress.

  • Misconception 2: Completing the 104 R form guarantees graduation.
  • While the form outlines the academic plan, it does not ensure that a student will graduate. Students must still meet all academic requirements set by their institution.

  • Misconception 3: The information provided on the 104 R form is not confidential.
  • The data submitted is protected under the Privacy Act of 1974. Institutions must handle this information with care to maintain confidentiality.

  • Misconception 4: The 104 R form is not necessary if a student is performing well academically.
  • Regardless of academic performance, the form is essential for documenting progress and ensuring compliance with ROTC program requirements.

  • Misconception 5: Only the student is responsible for filling out the 104 R form.
  • While students play a significant role, academic advisors and ROTC officials also contribute to ensuring the form is accurately completed and submitted.

  • Misconception 6: The 104 R form is a one-time requirement.
  • This form may need to be updated each semester or quarter to reflect changes in a student’s academic plan and progress.

  • Misconception 7: The 104 R form does not impact scholarship eligibility.
  • In fact, the information on this form can directly influence a student's eligibility for ROTC scholarships, as it helps determine academic standing and progression.

File Features

Fact Name Description
Authority This form is governed by Title 10, US Code 2101 and 2104.
Principal Purpose The form collects information necessary for managing the Army Senior ROTC program.
Routine Uses It provides a projected academic plan to verify if the applicant meets public law requirements.
Voluntary Disclosure Providing information is voluntary but essential for determining eligibility in the Army ROTC program.
Student Information Includes fields for the student's name, academic major, and GPA.
Course Details Students must list courses, credit hours, and grades for each term.
Signature Requirements Both the student and the registrar must sign the form, confirming its accuracy.