The 104 R form is a Planned Academic Program Worksheet used by students in the Army Senior ROTC program. This form collects essential information to ensure that students meet the academic requirements for commissioning in the Army. Completing the form accurately is crucial for maintaining eligibility and progressing through the ROTC program.
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The 104 R form, officially known as the Planned Academic Program Worksheet, serves a critical function within the Army Senior ROTC program. It is designed to collect essential information about a cadet's academic trajectory, ensuring that they meet the necessary requirements for commissioning into the Army. The form requires detailed entries, including the student's name, academic major, and credit hours completed, alongside their grade point average. Additionally, it outlines the courses the cadet plans to undertake, specifying credit hours and grades achieved. This information is vital for assessing whether the cadet will fulfill the public law requirements for their remaining academic years. The form also emphasizes the importance of voluntary disclosure, as providing accurate data is necessary for determining eligibility for continued participation in the ROTC program. Furthermore, signatures from both the student and an authorized official confirm the accuracy of the information and the student's understanding of their academic obligations. Overall, the 104 R form plays a pivotal role in facilitating the academic planning process for ROTC cadets, aligning their educational goals with the requirements of military service.
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:
CGPA:
Extension Center
a. Total required for degree:
1
Cross-Enrolled
(1) ROTC Hours that do not count:
(2) Total Hours Rqd for NAPS:
b. HOST SCHOOL
c. HOST FICE
Normal Academic Progression Standard
b. Credits toward degree Comp to date:
c. Transfer Credits accepted:
d. Remaining for Degree:
e. Number of authorized S/Qs:
7.TERM, YEAR, COURSE NUMBER, COURSE TITLE, COURSE CREDIT HOURS, CREDITS THAT COUNT TOWARDS ACADEMIC DEGREE, AND ACHIEVED GRADES.
a.
Year:
No.
Course Title
Hrs. Cts. Grd.
Total Term Hours:
d.
b.
e.
c.
f.
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
7.TERM, YEAR, COURSE NUMBER, COURSE TITLE, COURSE CREDIT HOURS, CREDITS THAT COUNT TOWARDS ACADEMIC DEGREE, AND ACHIEVED GRADES. (CONTINUED)
g.
h.
i.
j.
k.
l.
m.
n.
o.
Hrs.
Cts.
Grd.
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.
Page 2 of 3
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)
(PROFESSOR OF MILITARY SCIENCE SIGNATURE)
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Understanding the 104 R form is essential for students participating in the Army Senior ROTC program. However, several misconceptions exist about this form. Below is a list of ten common misunderstandings along with clarifications.
The 104 R form is a Planned Academic Program Worksheet used in the Army Senior ROTC program. This form helps manage the academic progress of selected students and ensures they meet the necessary requirements for commissioning in the Army. Several other forms and documents are often used in conjunction with the 104 R form to support the academic and administrative processes within the ROTC program. Below is a list of these related documents.
These forms and documents play crucial roles in the administration of the ROTC program, ensuring that cadets meet their academic and service obligations. Understanding these related documents can help cadets navigate their responsibilities more effectively.