104 R Template
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The 104 R form, known as the Planned Academic Program Worksheet, plays a vital 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 requirements for commissioning into the Army. It requires details such as the student's name, academic major, and credit hours, along with their grade point average (GPA). By outlining a projected academic plan, the form helps determine if the cadet has two remaining academic years to fulfill their degree requirements. Importantly, the form also addresses the student's voluntary disclosure of information, which is crucial for assessing eligibility for acceptance and continuation in the ROTC program. Throughout the process, students are encouraged to work closely with their academic advisors, ensuring they stay on track with their coursework and understand the implications of their academic choices. In essence, the 104 R form serves as a roadmap for students, guiding them toward successful completion of their academic and military objectives.
Key takeaways
Here are some key takeaways about filling out and using the 104 R form:
- Understand the Purpose: This form is essential for managing the Army Senior ROTC program. It helps determine if students meet the academic requirements for commissioning in the Army.
- Privacy Matters: The form collects personal data, and it’s important to know that providing this information is voluntary but necessary for eligibility.
- Accurate Information: Fill in your name, academic major, and other personal details accurately. Errors can lead to complications in your application.
- Track Your Progress: Use the form to list your courses, credit hours, and grades. This helps you and your advisors see if you’re on track for graduation.
- Consultation Required: Students must initial and date beside each term, indicating that they have been counseled about their academic plan.
- Review Course Requirements: Ensure that all listed courses are necessary for your degree completion. If not, note any exceptions on the back of the form.
- Signature Necessity: Don’t forget to sign the form. Both the student and the registrar or certifying official must sign it to validate the information.
- Scholarship Implications: If you’re on an ROTC scholarship, be aware that the scholarship will only be valid for the number of semesters indicated in the form.
- Keep Copies: Always keep a copy of the completed form for your records. This can be useful for future reference or if any questions arise.
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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. However, it is often accompanied by other important documents that support the application and enrollment process. Below are five commonly used forms and documents that complement the 104 R form.
- ROTC Enrollment Application: This application is the first step for students who wish to join the ROTC program. It collects personal information, academic background, and other relevant details necessary for the selection process.
- Scholarship Application Form: For those seeking financial assistance, this form outlines eligibility criteria and required documentation to apply for ROTC scholarships. It helps determine the financial support available to the student during their academic journey.
- Academic Transcript: An official record from the educational institution, the academic transcript provides a detailed account of the student’s academic performance. It is crucial for assessing eligibility and ensuring that the student meets the academic standards set by the ROTC program.
- Medical Examination Report: This document verifies that the student meets the health and fitness standards required for participation in the ROTC program. It includes results from a physical examination and any necessary medical history.
- Missouri Bill of Sale form - This legal document is essential for the transfer of ownership of personal property, and you can fill it out accurately by visiting https://missouriform.com.
- Statement of Understanding: This statement is signed by both the student and the professor of military science. It confirms that the student understands the requirements and commitments associated with the ROTC program, including the academic path outlined in the 104 R form.
These documents work together to create a comprehensive picture of the student’s qualifications and readiness for the ROTC program. Ensuring that all forms are accurately completed and submitted can significantly enhance the chances of successful enrollment and scholarship approval.
Dos and Don'ts
- Do read the entire form carefully before starting to fill it out.
- Do provide accurate and complete information for each section.
- Do double-check your academic major and CIP code for accuracy.
- Do ensure that all course titles and grades are correctly entered.
- Don't leave any required fields blank; this could delay processing.
- Don't forget to sign and date the form at the end.
- Don't use abbreviations or shorthand that may confuse reviewers.
- Don't submit the form without having it reviewed by an advisor or official.
Common mistakes
Filling out the 104 R form can be a daunting task, and many individuals make common mistakes that can lead to complications in their application process. Understanding these pitfalls can help ensure a smoother experience.
One frequent error occurs in the section where the student's name is required. Some applicants forget to include their middle initial, which can lead to discrepancies in official records. Ensuring that the name matches exactly with the identification documents is crucial.
Another common mistake is in the academic major section. Applicants sometimes enter a major that is not officially recognized by their institution. It is vital to verify that the major listed aligns with the university’s records to avoid confusion.
Inaccuracies in the CIP code can also create issues. This code is essential for identifying the specific field of study. Many individuals either leave this section blank or input an incorrect code, which can hinder the processing of their application.
When it comes to the credit hours section, applicants often miscalculate the total required for their degree. This mistake can lead to significant delays, as the institution may need to reach out for clarification. Double-checking the required credit hours against the academic catalog is advisable.
Another area of concern is the grade point average (GPA) entry. Some individuals mistakenly report their GPA without considering whether it is the cumulative or current GPA. Providing the correct type of GPA is essential for accurate assessment of academic standing.
Completing the course details section can also be challenging. Applicants frequently forget to include all relevant courses or mislabel the credit hours associated with each course. This oversight can complicate the review process, as all courses must be accounted for.
In addition, the initials and date section often goes overlooked. Students may forget to initial beside each term, which indicates that they have been counseled. This simple step is critical for maintaining transparency in the advising process.
Another mistake involves the review section, where applicants must confirm that all courses listed are required for degree completion. Some individuals neglect to check this box or fail to list exceptions on the reverse side, which can lead to confusion regarding their academic plan.
Finally, the signature and date fields are crucial. Many applicants overlook the need for both the student’s signature and the signature of the registrar or certifying official. Missing signatures can delay the processing of the form significantly.
By being aware of these common mistakes, individuals can take steps to ensure that their 104 R form is completed accurately. Attention to detail can make a significant difference in the success of their application process.
File Characteristics
| Fact Name | Details |
|---|---|
| Form Purpose | This form is used to provide a planned academic program for students in the Army Senior ROTC program. |
| Governing Authority | The authority for this form is Title 10, US Code 2101 and 2104. |
| Privacy Act Compliance | It complies with the Privacy Act Statement of 1974, ensuring the protection of personal data. |
| Voluntary Disclosure | Providing information is voluntary, but it affects eligibility for the Army ROTC program. |
| Academic Requirements | The form helps determine if the student meets the requirement of two remaining academic years. |
| Course Tracking | It includes sections for tracking courses, credit hours, and grades needed for degree completion. |
| Signatures Required | Students and certifying officials must sign the form to validate the planned academic program. |
Form Sample
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:
Page 1 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.
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, JUNE 2026
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, JUNE 2026 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 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.
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, JUNE 2026
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 cumulative G
PA 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.