⇨

Free 104 R Template

The 104 R form is a Planned Academic Program Worksheet used by the Army Senior ROTC program. This form collects essential information to help manage and process selected students for commissioning in the Army. Ensure you fill out the form accurately by clicking the button below.

Access 104 R Editor Here

Table of Contents

The 104 R form, known as the Planned Academic Program Worksheet, plays a crucial role in the Army Senior ROTC program. This form is designed to gather essential information about a cadet's academic journey, ensuring they meet the necessary public law requirements for commissioning in the Army. Key elements of the form include the student's name, academic major, credit hours, and grade point average. It also requires a detailed breakdown of courses taken, including term, year, course number, title, credit hours, and achieved grades. The information collected is vital for assessing the cadet's eligibility and academic progress, allowing institutions to manage their ROTC program effectively. Additionally, the form includes a statement of understanding, confirming that the cadet is pursuing a structured program that meets degree requirements. By completing this form, cadets help ensure they remain on track for graduation while fulfilling their commitments to the Army ROTC program.

Document Specifics

Fact Name	Details
Authority	This form is governed by Title 10, US Code 2101 and 2104.
Purpose	The form collects information necessary for managing the Army Senior ROTC program.
Privacy Act Compliance	It adheres to the Privacy Act Statement of 1974, ensuring personal data protection.
Voluntary Disclosure	Providing information is voluntary but necessary for eligibility in the Army ROTC program.
Student Information	It requires the student's name, academic major, and other personal details.
Academic Progress	The form assesses the academic plan to confirm compliance with public law requirements.
Course Tracking	Students must document their courses, credit hours, and grades for each term.
Signature Requirement	Both the student and the registrar must sign to validate the information provided.
Review Process	A review section confirms whether the listed courses meet degree completion requirements.
Statement of Understanding	Students acknowledge their understanding of the program's requirements and implications.

Similar forms

Form 1040: This is the standard individual income tax return form used in the United States. Like the 104 R form, it collects detailed information about the individual's financial situation to determine eligibility for specific programs or benefits.
Form W-2: Employers use this form to report wages paid to employees and taxes withheld. Similar to the 104 R, it provides essential information for assessing eligibility for financial aid or tax credits.
Form 1098-T: This form is used by educational institutions to report tuition payments and related expenses. It serves a similar purpose as the 104 R by helping students demonstrate eligibility for education-related tax benefits.
Vehicle Sale and Transfer Form: This form, essential for transactions involving vehicles 1972 or older and non-titled vehicles, ensures that transfers are documented legally, much like the necessary paperwork needed for students in academic processes. For more details, visit nytemplates.com/blank-new-york-mv51-template/.
Form FAFSA: The Free Application for Federal Student Aid collects information to determine eligibility for federal student financial aid. Like the 104 R, it requires detailed academic and financial information.
Form I-20: This form is issued to international students to apply for a student visa. It outlines the student's academic program, similar to how the 104 R outlines a student's planned academic program.
Form 8862: This is used to claim the Earned Income Tax Credit after it has been denied. It requires information about qualifications, akin to how the 104 R verifies eligibility for ROTC.
Form 941: Employers use this form to report income taxes, Social Security tax, and Medicare tax withheld from employee's paychecks. Like the 104 R, it collects important data for compliance and eligibility assessments.
Form 4506-T: This form allows individuals to request a transcript of their tax return. It serves a similar function as the 104 R by providing necessary documentation for verifying financial status.
Form 1099: This form is used to report various types of income other than wages, salaries, and tips. It helps assess an individual's financial situation, similar to how the 104 R evaluates a student's academic path.

Free 104 R File

104 R 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:

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

Understanding 104 R

What is the purpose of the 104 R form?

The 104 R form, officially known as the Planned Academic Program Worksheet, serves to gather essential information for managing the Army Senior ROTC program. It helps in assessing whether students meet the requirements for commissioning into the Army. The form ensures that the academic plans align with public law and Army regulations.

Who needs to complete the 104 R form?

Students participating in the Army ROTC program must complete the 104 R form. This includes cadets who are pursuing a degree and need to outline their academic progression for the remaining years of their program. The form is crucial for those seeking to maintain their eligibility for ROTC scholarships and commissioning opportunities.

What information is required on the 104 R form?

The form requires various details, including the student's name, academic major, academic school, credit hours, and grade point average (GPA). Additionally, students must list their course information for each term, including course titles, credit hours, and achieved grades. This comprehensive data helps in evaluating the student's academic trajectory.

How does the 104 R form impact a student's ROTC eligibility?

Completing the 104 R form is vital for determining a student's eligibility for acceptance, continuation, or discontinuation in the Army ROTC program. The information provided helps verify that the student meets the necessary academic standards and remains on track to fulfill their degree requirements.

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

Providing the information on the 104 R form is voluntary; however, failing to do so may adversely affect a student's eligibility for the ROTC program. Without accurate data, the program administrators may not be able to assess the student's academic standing or future prospects within the ROTC framework.

How often should the 104 R form be updated?

Students should update the 104 R form at least once per academic term or whenever there are significant changes to their academic plans. Regular updates ensure that the information remains accurate and reflects the student’s current academic status, which is essential for effective program management.

What is the significance of the Statement of Understanding section on the 104 R form?

The Statement of Understanding section confirms that the cadet acknowledges the academic program outlined on the form is approved and necessary for their degree completion. This statement underscores the commitment of both the cadet and the educational institution to adhere to the requirements of the ROTC program and the degree being pursued.

Dos and Don'ts

When filling out the 104 R form, careful attention to detail is essential. Here are some important dos and don’ts to keep in mind:

Do ensure that all personal information is accurate and complete.
Do double-check the academic major and CIP code for correctness.
Do use the correct date format (MM/DD/YYYY) throughout the form.
Do provide clear and legible course titles and grades.
Don’t leave any sections blank; if a section is not applicable, indicate that clearly.
Don’t forget to have the student initial and date beside each term after counseling.
Don’t rush through the form; take your time to ensure accuracy.
Don’t ignore the review section; ensure that all listed courses are necessary for degree completion.

Check out Common Templates

Salary Advance Agreement - This form allows you to formally outline your financial situation for an advance.

When considering the best way to designate authority in financial or legal matters, it is crucial to understand the implications of the Arizona Power of Attorney form. This document not only empowers an agent to act on the principal's behalf but also ensures that the principal's wishes are honored during incapacitating circumstances. For those looking to access the necessary documentation, the Arizona PDF Forms provide a reliable source to obtain and fill out the Power of Attorney form effectively.

California Tb Risk Assessment - Testing sites must adhere to local health regulations and protocols.