104 R PDF Template

104 R PDF Template

The 104 R form, also known as the Planned Academic Program Worksheet, is an essential document used in the Army Senior ROTC program. This form serves to outline a student's academic plan, ensuring that they meet the necessary requirements for commissioning into the Army. By providing a detailed overview of coursework and academic progress, it plays a crucial role in determining eligibility for continued participation in the ROTC program.

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Article Guide

The 104 R form serves as a vital tool for students enrolled in the Army Senior ROTC program. It outlines a planned academic program that ensures students meet the necessary requirements for commissioning in the Army. This form is designed to collect essential information about a student’s academic progress, including their major, credit hours, and grade point average. By documenting courses taken and those planned for the future, it helps students and advisors track academic progression over the remaining years of study. The form also emphasizes the importance of voluntary disclosure, as the information provided plays a crucial role in determining eligibility for continued participation in the ROTC program. Additionally, signatures from both the student and a certifying official are required, ensuring accountability and commitment to the outlined academic plan. Overall, the 104 R form is not just a bureaucratic necessity; it is a structured pathway guiding future leaders through their educational journey while fulfilling Army requirements.

104 R Preview

For use of this form, see USACC Pam 145-4, the proponent agency is ATCC-PAS
PLANNED ACADEMIC PROGRAM WORKSHEET
DATA REQUIRED BY PRIVACY ACT STATEMENT OF 1974
AUTHORITY:
PRINCIPAL PURPOSE:
ROUTINES USE(S):
VOLUNTARY DISCLOSURE:
Title 10, US Code § 2101 and 2104 and 2107 and 2107a.
To provide information and data necessary for administering Army Senior ROTC program, processing, and managing of selected students for commissioning in the Army IAW
established public law and Army Regulations.
To provide a projected academic plan to determine if the applicant meets the public law requirements of two remaining academic years.
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)
6. GRADE POINT AVERAGE (GPA)
Term:
Term:
rm:
8. ACADEMIC SCHOOL
IDENTIFICATION (Check one):
Curr GPA: CGPA:
Curr GPA:
CGPA:
Term: Term:
Curr GPA:
CGPA:
Curr GPA:
CGPA:
a. Bde
Term:
Term:
Curr GPA:
CGPA:
Curr GPA:
CGPA:
Term:
Term:
Curr GPA:
CGPA:
Curr GPA:
CGPA:
Term: Term:
Curr GPA:
CGPA:
Curr GPA:
CGPA:
9. TERM, YEAR, COURSE NUMBER (No.), COURSE TITLE, COURSE CREDIT HOURS (Hrs), ACHIEVED GRADES (Grd), AND DISTANCE LEARNING (DL).
a.
b.
d.
e.
c.
f.
TERM 1:
TERM 2:
10. STUDENT INITIALS & DATE:
(Have the student initial and date beside each term they
have completed to indicate they have been counseled.
TERM 3:
TERM 4:
TERM 5:
TERM 6:
TERM 7:
TERM 8:
TERM 9:
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Term:
No. Course Title Hrs. DL? Grd.
Total Term Hours:
Term:
No. Course Title Hrs.
DL? Grd.
Total Term Hours:
Term:
No. Course Title Hrs. DL? Grd.
Term:
No. Course Title Hrs.
DL? Grd.
Total Term Hours:
Term:
No. Course Title Hrs.
DL? Grd.
Total Term Hours:
No. Course Title Hrs.
DL? Grd.
Total Term Hours:
4. Type of Degree Currently Pursuing
7.
b. HOST SCHOOL
c. ACADEMIC SCHOOL
5.
CREDIT HOURS
Select Semester or Quarter
a. Total Required for degree:
(1) ROTC Hours that do not count:
(2) Total Hours Rqd for degree:
Number of Required Hrs per Term:
b. Credits toward degree Comp to date:
c. Transfer Credits accepted:
d. Remaining for Degree:
e. Number of Authorized S/Qs:
Term:
Total Term Hours:
PREVIOUS EDITIONS ARE OBSOLETE
Cadet ID
Year:
Year:
Year:
Year:
Year:
Year:
TERM 10:
TERM 11:
TERM 12:
USACC Form 104-R, JULY 2025
OMB Control Number: 0702-XXXX
OMB Expiration Date: XX/XX/XXXX
The public reporting burden for this collection of information, 0702-XXXX, is estimated to average 25 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions for
reducing the burden, to the Department of Defense, Washington Headquarters Services, whs.mc.alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other
provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR COMPLETED
FORM TO THE ABOVE ORGANIZATION. RETURN COMPLETED FORM TO REQUESTING ROTC PROGRAM.
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PLANNED ACADEMIC PROGRAM WORKSHEET
For use of this form, see USACC Pam 145-4, the proponent agency is ATCC-PAS
11. TERM, YEAR, COURSE NUMBER (No.), COURSE TITLE, COURSE CREDIT HOURS (Hrs), ACHIEVED GRADES (Grd), AND DISTANCE LEARNING (DL). (CONTINUED)
g.
h.
j. k.
m.
n.
i.
l.
o.
12. REVIEW: All of the above courses are required (as minimum) for the completion of the degree:
Completion should result in a
No (if no, list exceptions on reverse of this form).
13. SIGNATURE OF STUDENT: 14. DATE: (MM/DD/YYYY)
15. SIGNATURE OF REGISTRAR AND EXAMINER OF CREDENTIALS OR ROTC ADVISOR (OR OTHER INSTITUTION CERTIFYING OFFICIAL):
16. DATE: (MM/DD/YYYY)
USACC Form 104-R, JULY 2025 Page 2 of 3
Term:
No. Course Title Hrs. DL? Grd.
Total Term Hours:
Term:
No. Course Title Hrs.
DL? Grd.
Total Term Hours:
Term:
No. Course Title Hrs.
DL? Grd.
Total Term Hours:
Term:
No. Course Title Hrs.
DL?
Grd.
Total Term Hours:
Term:
No. Course Title
Hrs.
DL? Grd.
Total Term Hours:
Term:
No. Course Title Hrs.
DL? Grd.
Total Term Hours:
Term:
No. Course Title Hrs.
DL? Grd.
Total Term Hours:
Term:
No. Course Title
Hrs.
DL? Grd.
Total Term Hours:
Term:
No. Course Title
Hrs.
DL?
Grd.
Total Term H
ours:
(Degree Type)
Yes
Completion Date (Month, Year)
(Academic Discipline)
PREVIOUS EDITIONS ARE OBSOLETE
Year:
Year:
Year:
Year:
Year:
Year:
Year:
Year: Year:
OMB Control Number: 0702-XXXX
OMB Expiration Date: XX/XX/XXXX
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PLANNED ACADEMIC PROGRAM WORKSHEET
For use of this form, see USACC Pam 145-4, the proponent agency is ATCC-PAS
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 or graduate degree program of no more than two years; and that the remaining credit hour
s 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.
IAW USACC Pam 145-4, the worksheet must be reviewed annually (at a minimum) for each contracted Cadet and revised, as necessary. The worksheet
must be authenticated by an appropriate school academic official (academic advisor/counselor) when completed or revised. The PMS will review the
worksheet with the Cadet each school term to monitor alignment/mission set and academic progress. This review will be noted on Cadet counseling records.
Any changes to this degree plan, adding/dropping classes, or change of major must first be discussed/approved with the PMS.
(Date) (MM/DD/YYYY)
(Date) (MM/DD/YYYY)
(CADET SIGNATURE)
(PROFESSOR OF MILITARY SCIENCE SIGNATURE)
USACC Form 104-R, JULY 2025
Page 3 of 3
PREVIOUS EDITIONS ARE OBSOLETE
OMB Control Number: 0702-XXXX
OMB Expiration Date: XX/XX/XXXX
Instructions for Planned Academic Program Worksheet USACC 104-R
Reset Form button erases the form.
1. Cadet’s name and Cadet ID
2. Cadet’s Academic Major. 2a. Only used for HQ STEM Scholarships. Not necessary for
all other scholarships.
3. Date of form preparation or date of form update.
4. Select type of degree the Cadet is pursuing Bachelors, Masters, or Associates (MJC
Only).
5. Block 5 calculates how many scholarship terms the Cadet needs to graduate.
Dropdown: select appropriate term type and degree plan. NOTE: Making the correct
selection is required for Block 5 to calculate correctly.
a. Input the total hours required for the degree
1) Input ROTC hours that are not included in the total for the degree.
2) Populates the sum of 5a and 5a(1)
3) Calculates the average number of hours required for each term based
on the selection in the dropdown and the sum from 5a(2).
b. Input the number of credit hours the Cadet has completed (if any) to date at the
school.
c. Input any transfer credits the school has accepted.
d. Calculates how many hours the Cadet has remaining for their degree.
e. Calculates the number of scholarship terms the Cadet needs to complete their
degree based on calculations from 5a(3) and 5d.
6. Input the term GPA and the cumul
ative GPA for each term completed.
7. Select the Cadet’s Brigade, ROTC Program, and Academic School.
8. Select Academic School’s identification: If the academic school is the same as the Host
School, select Host; If the academic school is not the Host School, select either
Extension Unit or Cross-Town.
1. Host Academic School is the Same as Host School.
2. Extension Unit Academic School is a manned partner school.
3. Cross-Town Academic School is an unmanned partner school.
NOTE: Cadet must take ROTC classes at Host school or nearest
manned Extension Unit.
9. Each group represents one term. Select the term from the dropdown: Fall, Winter (for
quarter schools), Spring, or Summer; Select the year for the term selected; input the
Course Number, Course Title, course Credit Hours, check the column for DL? if the
class is online. Once the term is finished, input the grade received.
10. Student should initial and date beside each term.
11. Follow the instructions for #9 above.
12. Verify that the courses listed above in #9 and #11 are required for the degree. Input the
expected graduation date.
13. Signature of Cadet.
14. Date Cadet signed document.
15. Signature of Registrar or ROTC advisor and other institution certifying official.
16. Date certifying official signed document.
17. Statement of Understanding. Cadet should read the Statement of Understanding and
then sign and date; PMS should sign and date.

File Properties

Fact Name Details
Authority This form is authorized under Title 10, US Code 2101 and 2104, which governs the Army Senior ROTC program.
Purpose The primary purpose of the 104 R form is to collect necessary information for managing students in the Army ROTC program.
Privacy Act Compliance It adheres to the Privacy Act Statement of 1974, ensuring that personal data is handled with care and confidentiality.
Voluntary Disclosure Providing information is voluntary, but it is crucial for determining eligibility in the ROTC program.

Instructions on Utilizing 104 R

Completing the 104 R form is essential for students in the Army Senior ROTC program. Follow these steps carefully to ensure all necessary information is accurately provided.

  1. Enter Student Name: Fill in the student's last name, first name, and middle initial in the designated section.
  2. Specify Academic Major: Write down the student's major field of study.
  3. Input CIP Code: Include the Classification of Instructional Programs (CIP) code associated with the major.
  4. Record Date: Indicate the date of form preparation in MM/DD/YYYY format.
  5. Identify Academic School: State the name of the school where the student is enrolled.
  6. Detail Credit Hours: Fill in the total credit hours required for the degree.
  7. Provide GPA: Enter the current Grade Point Average (GPA) along with semester or quarter designation.
  8. List Courses: For each term, specify the term, year, course number, course title, credit hours, credits that count towards the academic degree, and achieved grades. Repeat for all relevant terms.
  9. Initials and Dates: Have the student initial and date beside each term to confirm counseling.
  10. Review Course Requirements: Indicate whether all listed courses are required for degree completion by selecting YES or NO.
  11. Student Signature: The student must sign the form.
  12. Registrar Signature: Obtain the signature of the registrar or certifying official.
  13. Final Dates: Ensure the date is filled in next to the registrar’s signature in MM/DD/YYYY format.

Important Facts about 104 R

What is the purpose of the 104 R form?

The 104 R form, also known as the Planned Academic Program Worksheet, is designed to collect information about a student's academic program. It helps in managing and administering the Army Senior ROTC program. This form ensures that students meet the necessary requirements for commissioning in the Army.

Who needs to fill out the 104 R form?

Students participating in the Army ROTC program must complete the 104 R form. This includes cadets who are planning their academic courses and need to demonstrate that they are on track to meet their degree requirements.

What information is required on the 104 R form?

The form requires various details, including the student's name, academic major, credit hours, grade point average (GPA), and a list of courses taken or planned. Students must also indicate their academic progression and any transfer credits accepted.

How does the 104 R form affect ROTC scholarship eligibility?

Completing the 104 R form is crucial for determining a cadet's eligibility for ROTC scholarships. The information provided helps assess whether the student is on track to complete their degree within the required timeframe, which is essential for scholarship continuation.

What happens if a student does not provide the requested information?

If a student chooses not to provide the necessary information on the 104 R form, it may affect their eligibility for acceptance or continuation in the Army ROTC program. Voluntary disclosure is vital for evaluating a student's academic standing.

How is the information on the 104 R form used?

The information collected on the 104 R form is used to create a projected academic plan. This plan helps determine if the student meets the public law requirements for their remaining academic years and ensures they are progressing appropriately towards their degree.

What is the significance of the Statement of Understanding section?

The Statement of Understanding section of the 104 R form confirms that the student and the professor of military science acknowledge the academic program outlined in the worksheet. It signifies that the program is officially approved and meets the requirements for the intended degree.

How does a student indicate they have been counseled?

Students must initial and date beside each term on the 104 R form to indicate that they have been counseled about their academic plan. This step is important for accountability and ensures that students are aware of their academic progress.

What is the role of the registrar or certifying official?

The registrar or another certifying official must sign and date the 104 R form to validate the information provided. Their signature confirms that the academic details are accurate and that the student is on track to meet their degree requirements.

Can the 104 R form be updated after submission?

Yes, the 104 R form can be updated if there are changes in a student's academic plan or course enrollment. It is important to keep the information current to ensure proper management of the ROTC program and scholarship eligibility.

Common mistakes

Filling out the 104 R form can be a straightforward process, but there are common mistakes that applicants often make. Awareness of these pitfalls can help ensure that the form is completed accurately and efficiently.

One frequent error is failing to provide the correct name of the student in the designated section. It is essential to include the last name, first name, and middle initial. Omitting any part of this information can lead to confusion and delays in processing the application.

Another mistake involves the academic major and its corresponding CIP code. Applicants sometimes enter an incorrect major or fail to include the CIP code altogether. This code is critical for identifying the specific field of study and ensuring that the academic plan aligns with the ROTC program requirements.

Many individuals overlook the as of date field, which should reflect the date of form preparation. Leaving this blank can cause administrative issues, as it is necessary for tracking the timeline of the application.

Inaccurate reporting of credit hours and grade point averages (GPA) is also common. Applicants must ensure that they enter the correct numbers for both current GPA and cumulative GPA, as well as the total credit hours required for their degree. Errors in these figures can affect eligibility and academic standing within the ROTC program.

Additionally, some individuals fail to check the appropriate identification box for their academic status, such as whether they are attending a host school or an extension center. This information is vital for the institution to understand the applicant's educational context.

When listing courses, applicants may mistakenly omit crucial details, such as course titles, credit hours, or achieved grades. Each course must be accurately documented to provide a clear picture of the academic path. Missing this information can lead to misunderstandings regarding course completion and degree requirements.

Another common oversight is the initialing and dating section. Students must initial and date beside each term to confirm they have been counseled on their academic progress. Failing to do this can result in a lack of acknowledgment of the guidance received.

Lastly, applicants sometimes forget to sign and date the form at the bottom. This signature is a declaration of understanding regarding the academic program outlined in the worksheet. Without it, the form may be considered incomplete and could delay processing.

By being mindful of these common mistakes, individuals can improve their chances of successfully completing the 104 R form and moving forward in 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 helps outline the academic path necessary for commissioning in the Army. Alongside this form, there are several other documents that students may need to complete their ROTC requirements. Below is a list of related forms and documents that are commonly used in conjunction with the 104 R form.

  • ROTC Scholarship Application: This document allows students to apply for financial assistance through the ROTC program. It collects personal information, academic records, and other relevant details to assess eligibility for scholarships.
  • Cadet Enrollment Application: This form is required for students who wish to enroll in the ROTC program. It gathers basic information about the student, their academic background, and their commitment to the program.
  • Academic Advising Form: This form is used to document meetings between cadets and academic advisors. It helps ensure that students are on track with their degree requirements and ROTC obligations.
  • Course Registration Form: This document is necessary for cadets to officially register for classes each term. It includes details about the courses they plan to take, ensuring they meet both academic and ROTC requirements.
  • Service Commitment Agreement: This agreement outlines the cadet's commitment to serve in the Army after graduation. It specifies the duration of service and other obligations associated with the ROTC program.
  • Fitness Assessment Form: This form tracks the physical fitness progress of cadets. Regular assessments are required to ensure that students meet the physical standards necessary for commissioning.

These documents collectively support the academic and military development of ROTC cadets. Each form plays a vital role in ensuring that students remain compliant with both their educational and military commitments. Properly completing and submitting these forms is crucial for a successful experience in the ROTC program.

Similar forms

  • Academic Plan Worksheet: Similar to the 104 R form, an Academic Plan Worksheet outlines a student's academic trajectory. It typically includes details about required courses, credits, and expected graduation timelines. Both documents serve to ensure that students are on track to meet their academic goals.
  • Degree Audit Report: This document provides a comprehensive review of a student’s academic progress. Like the 104 R form, it assesses completed courses, credits earned, and remaining requirements for graduation, helping students and advisors identify any gaps in their academic journey.
  • Course Registration Form: A Course Registration Form is used to enroll in specific classes for a term. Similar to the 104 R form, it requires students to outline their intended courses and credit hours, ensuring that they meet the necessary academic requirements for their degree.
  • Transfer Credit Evaluation: This document evaluates previously earned credits from other institutions. It shares similarities with the 104 R form in that it determines how these credits apply toward a student’s current degree program, ensuring that students receive appropriate recognition for their prior academic work.

Dos and Don'ts

When completing the 104 R form, it is essential to follow certain guidelines to ensure accuracy and compliance. Below is a list of actions to take and avoid while filling out this form.

  • Do provide accurate personal information, including your full name and academic major.
  • Do check the academic requirements carefully to ensure you meet the public law requirements for the ROTC program.
  • Do use the correct format for dates, specifically MM/DD/YYYY, to avoid confusion.
  • Do have your academic advisor review the completed form for any potential errors or omissions.
  • Do ensure that all required signatures are obtained before submission.
  • Don't leave any sections blank; incomplete forms may lead to processing delays.
  • Don't use abbreviations that could cause misunderstanding; clarity is crucial.
  • Don't submit the form without double-checking for accuracy in course titles and credit hours.
  • Don't forget to indicate whether all listed courses are required for your degree completion.
  • Don't ignore the privacy statement; be mindful of the information you disclose.

Misconceptions

Understanding the 104 R form is essential for students involved in the Army ROTC program. However, several misconceptions exist. Here are ten common misunderstandings:

  1. The 104 R form is only for ROTC scholarship recipients. This form is necessary for all students in the Army ROTC program, not just those receiving scholarships.
  2. Filling out the form is optional. While it may seem optional, completing the form is crucial for determining eligibility and academic planning.
  3. The form only tracks grades. It also outlines credit hours, academic majors, and future course plans, providing a comprehensive academic overview.
  4. Only the student needs to sign the form. The form requires signatures from both the student and a certifying official, such as a registrar or professor.
  5. The form is only relevant for one semester. It encompasses the entire academic program, tracking progress over multiple terms.
  6. Submitting the form guarantees graduation. While it helps in planning, it does not ensure graduation, as other academic requirements must also be met.
  7. The form is the same for all institutions. Each institution may have specific requirements or variations in how the form is completed.
  8. Once submitted, the form cannot be changed. Students can update the form as needed, especially if there are changes in their academic plans.
  9. The 104 R form is only for new cadets. It is used throughout a cadet's time in the program to monitor academic progress and requirements.
  10. Completing the form is a one-time task. Regular updates are necessary to reflect changes in courses, grades, and academic goals.

Addressing these misconceptions can help students navigate their academic journey more effectively within the Army ROTC program.

Key takeaways

When filling out and using the 104 R form, here are some key takeaways to keep in mind:

  • Purpose of the Form: The 104 R form serves to provide essential information for managing students in the Army Senior ROTC program.
  • Voluntary Disclosure: While providing information is voluntary, it is crucial for determining eligibility in the ROTC program.
  • Accurate Information: Ensure that all personal details, including name and academic major, are accurate to avoid processing delays.
  • Course Details: List all courses taken, including course numbers, titles, credit hours, and grades achieved.
  • Signatures Required: The form must be signed by both the student and a certifying official to validate the academic program.
  • Review Process: Review all courses listed to confirm they are required for degree completion; indicate any exceptions if necessary.
  • Timeliness: Complete the form in a timely manner, especially if it impacts scholarship eligibility and academic progression.