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Outline

The 104 R form, officially known as the Planned Academic Program Worksheet, plays a crucial role in the Army Senior ROTC program. This document is essential for students seeking commissioning in the Army, as it collects vital information necessary for program administration. The form requires students to outline their academic plans, detailing their major, credit hours, and grade point averages. It also includes sections for listing courses taken and grades achieved, ensuring that students meet the public law requirements for their remaining academic years. The information provided helps determine eligibility for acceptance, continuation, or discontinuation in the ROTC program. Importantly, the form emphasizes voluntary disclosure, which is necessary for assessing a student's academic standing and progression toward degree completion. This comprehensive approach not only aids in managing student records but also supports the academic success of future Army leaders.

Sample - 104 R Form

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, 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, [email protected]. 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.

Form Information

Fact Name Description
Authority The 104 R form is governed by Title 10 of the U.S. Code, specifically sections 2101 and 2104, which outline the legal framework for the Army Senior ROTC program.
Principal Purpose This form serves to collect essential information for managing and processing selected students in the Army ROTC program, ensuring they meet public law requirements.
Routine Use The information provided is used to project an academic plan that helps determine if the applicant satisfies the necessary criteria for two remaining academic years.
Voluntary Disclosure While providing information is voluntary, it is crucial for assessing an individual's eligibility for acceptance or continuation in the Army ROTC program.

Detailed Guide for Filling Out 104 R

Filling out the 104 R form is essential for students participating in the Army Senior ROTC program. This form helps gather the necessary information to ensure that students are on track for their academic goals. Below are the steps to complete the form correctly.

  1. Enter the student's full name in the format: LAST, FIRST, MI.
  2. Provide the academic major.
  3. Fill in the CIP code.
  4. Input the date of form preparation in MM/DD/YYYY format.
  5. Specify the academic school.
  6. List the total credit hours required for the degree.
  7. Include the current grade point average (GPA) and select whether it's based on semester or quarter.
  8. Identify if the student is attending a host school, extension center, or cross-enrolled. Check the appropriate box.
  9. Detail the academic progress by filling in the required fields for current GPA, total required for degree, and remaining credits.
  10. For each term, list the year, course number, course title, credit hours, credits that count towards the degree, and achieved grades. Repeat this for all terms.
  11. Have the student initial and date beside each term to confirm they have been counseled.
  12. Indicate whether all courses listed are required for degree completion by checking YES or NO. If NO, list exceptions on the back of the form.
  13. Obtain the student’s signature and the date.
  14. Get the signature of the registrar or certifying official and the date.
  15. Complete the statement of understanding section, including signatures and dates for the cadet and the professor of military science.

Obtain Answers on 104 R

  1. What is the purpose of the 104 R form?

    The 104 R form, known as the Planned Academic Program Worksheet, serves a critical role in the administration of the Army Senior ROTC program. It collects essential information about a cadet’s academic plan to ensure they meet the necessary requirements for commissioning in the Army. This includes evaluating whether the cadet has two remaining academic years to fulfill their degree requirements.

  2. Who needs to fill out the 104 R form?

    The form must be completed by students participating in the Army ROTC program. Specifically, it is designed for cadets who are planning their academic coursework to ensure they can successfully meet their degree requirements within the allotted time. This helps in tracking their academic progress and eligibility for continued participation in the program.

  3. What information is required on the 104 R form?

    Several key pieces of information are needed on the 104 R form, including:

    • The student's name and academic major
    • The date of form preparation
    • Details of the academic school, including credit hours and grade point average (GPA)
    • A list of courses taken, including course numbers, titles, credit hours, and grades achieved

    This information is vital for assessing the cadet's academic standing and progress toward their degree.

  4. What happens if a cadet does not provide the required information?

    Providing information on the 104 R form is voluntary; however, it is crucial for determining a cadet's eligibility for acceptance, continuance, or discontinuance in the Army ROTC program. Without this information, it may be challenging for the program administrators to make informed decisions regarding the cadet's academic standing and future in the program.

  5. How does the 104 R form impact a cadet's scholarship?

    If a cadet is a participant in the ROTC Scholarship program, the 104 R form outlines the number of semesters for which the scholarship will be in effect. It is essential for ensuring that the scholarship remains valid as long as the cadet is on track to complete their degree requirements as specified in the form. This connection emphasizes the importance of maintaining accurate and up-to-date information on the worksheet.

Common mistakes

Filling out the 104 R form can be a straightforward process, but several common mistakes can lead to delays or complications. One frequent error is not providing the full name of the student as required in the first section. Omitting middle initials or using nicknames can cause confusion and may result in processing issues.

Another common mistake involves the academic major section. Applicants sometimes fail to list their major accurately or neglect to include the correct Classification of Instructional Programs (CIP) code. This information is crucial for determining eligibility and ensuring that the academic program aligns with ROTC requirements.

Many individuals also overlook the importance of the AS OF DATE. This date should reflect when the form is completed. Failing to provide the correct date can lead to questions about the validity of the information submitted.

In the section detailing credit hours and grade point average (GPA), mistakes are often made. Some applicants may report incorrect GPAs or fail to distinguish between cumulative and current GPAs. It is essential to double-check these figures to ensure they accurately reflect academic performance.

Another error occurs in the course listing section. Applicants sometimes forget to include all relevant courses or mislabel course titles and credit hours. This can lead to an incomplete academic picture and potential eligibility issues.

Additionally, not having the student initials and date beside each term can create problems. This step confirms that the student has been counseled on their academic plan. Missing initials may suggest a lack of understanding or oversight.

Some individuals also neglect to review the review section at the end of the form. Failing to indicate whether all courses listed are required for degree completion can lead to misunderstandings about the student’s academic status.

Finally, signing and dating the form correctly is crucial. Many applicants forget to include the signatures of the registrar or certifying official. Without these signatures, the form may not be considered valid, potentially delaying the student's academic progress.

Documents used along the form

The 104 R form is an important document used in the Army Senior ROTC program. It helps to outline a student's academic plan and ensure they meet the necessary requirements for commissioning. Along with the 104 R form, several other documents are commonly used. Below is a list of these forms and a brief description of each.

  • ROTC Scholarship Application: This form is used by students applying for ROTC scholarships. It collects personal information, academic history, and details about extracurricular activities.
  • Cadet Enrollment Form: This document registers students into the ROTC program. It includes personal details and confirms the student's commitment to the program.
  • Medical Examination Report: This report provides information on a student's medical fitness for military service. A qualified medical professional must complete it.
  • Transcript Request Form: Students use this form to request their academic transcripts from their educational institution. Transcripts are essential for verifying academic performance.
  • Financial Aid Form: This document helps students apply for financial assistance. It includes information about the student’s financial situation and educational expenses.
  • Course Registration Form: This form is used to enroll in specific courses each semester. It ensures that students are registered for classes that align with their academic goals.
  • Statement of Understanding: This document outlines the expectations and responsibilities of the cadet within the ROTC program. Both the cadet and the professor of military science must sign it.
  • Degree Audit Form: This form tracks the progress of a student's academic requirements for graduation. It helps ensure that all necessary courses are completed.
  • Evaluation Form: Instructors use this form to assess a cadet's performance in the ROTC program. It provides feedback on leadership skills and overall participation.

These documents work together to support students in the Army ROTC program. Each form plays a specific role in ensuring that students are prepared for their future military careers.

Similar forms

  • Form 1040: This is the standard individual income tax return form used in the United States. Like the 104 R form, it requires detailed information about the individual’s situation, including income and deductions. Both forms aim to provide a clear picture of the individual's status, whether for tax or academic purposes.
  • Form I-20: Issued by educational institutions to foreign students, this form certifies eligibility for student status in the U.S. Similar to the 104 R, it requires personal information and outlines the academic program. Both documents help to ensure that individuals meet specific eligibility criteria.
  • FAFSA (Free Application for Federal Student Aid): This form is used to apply for financial aid for college. Like the 104 R, it collects personal and academic information to assess eligibility for funding. Both forms are crucial for students navigating their educational paths.
  • Form DD-214: This document is issued to military veterans upon discharge. It contains information about service and education, similar to the 104 R's focus on academic progress. Both forms serve as important records for their respective purposes.
  • Form 1098-T: This form is used by educational institutions to report tuition payments and related expenses. Like the 104 R, it provides vital information for financial and academic assessment, ensuring that students can access necessary resources for their education.

Dos and Don'ts

When filling out the 104 R form, there are several important things to keep in mind to ensure accuracy and compliance. Here’s a list of what to do and what to avoid:

  • Do provide accurate and complete information in all sections.
  • Do double-check your academic major and CIP code for correctness.
  • Do make sure all course titles and grades are clearly listed and legible.
  • Do ensure that the student initials and dates are filled in next to each term.
  • 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 submit the form without reviewing it for any errors or omissions.

By following these guidelines, you can help ensure that the form is completed correctly and efficiently. It's important to take your time and verify each entry to avoid any potential issues down the line.

Misconceptions

Understanding the 104 R form is crucial for students in the Army ROTC program. However, several misconceptions can lead to confusion. Here are five common misunderstandings:

  • It is only for new students. The 104 R form is not limited to new students. It is also used by current students to outline their academic plans and ensure they meet ROTC requirements.
  • Completion guarantees a scholarship. Filling out the form does not automatically secure a scholarship. Eligibility is determined based on various factors, including academic performance and program requirements.
  • All courses listed are mandatory. While the form helps track required courses, not all listed courses may be mandatory for graduation. Students should consult their academic advisors for clarification.
  • It can be submitted at any time. There are specific deadlines for submitting the 104 R form. Missing these deadlines can affect a student's standing in the program.
  • Only one signature is needed. The form requires multiple signatures, including that of the student and the registrar. This ensures all parties are informed and in agreement regarding the academic plan.

Addressing these misconceptions is essential for a smooth academic journey in the ROTC program. Students are encouraged to seek guidance if they have questions about the 104 R form.

Key takeaways

Here are key takeaways about filling out and using the 104 R form:

  • The 104 R form is used to outline a planned academic program for students in the Army Senior ROTC program.
  • It requires the student's full name, academic major, and the date the form is prepared.
  • The form includes a section for the student’s credit hours and grade point average (GPA), which are critical for assessing eligibility.
  • Students must indicate whether the courses listed are required for their degree completion.
  • Each term requires the student to list course numbers, titles, credit hours, and grades achieved.
  • Students must initial and date each term to confirm they have been counseled on their academic plan.
  • Completing the form is voluntary, but it is essential for determining eligibility for the ROTC program.
  • Students must sign the form, along with a registrar or certifying official, to validate the information provided.
  • It is important to keep a copy of the completed form for personal records and future reference.