Free 104 R Form
Form Preview Example
PLANNED ACADEMIC PROGRAM WORKSHEET
For use of this form, see USACC Pam
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.
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1. NAME OF STUDENT (LAST, FIRST, MI) |
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2. ACADEMIC MAJOR |
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2a. CIP CODE |
3. AS OF DATE (MM/DD/YYYY) (Date of form preparation) |
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4. ACADEMIC SCHOOL |
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5. CREDIT HOURS |
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6. GRADE POINT AVERAGE (GPA) |
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Select Semester or Quarter (S/Q) |
Semester |
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Term: |
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Term: |
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a. IDENTIFICATION (Check one): |
Host |
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Curr GPA: |
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CUM: |
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Curr GPA: |
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CGPA: |
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Extension Center |
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a. Total required for degree: |
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1 |
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Term: |
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Term: |
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(1) ROTC Hours that do not count: |
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Curr GPA: |
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CUM: |
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Curr GPA: |
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CGPA: |
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(2) Total Hours Rqd for NAPS: |
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Term: |
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Term: |
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b. HOST SCHOOL |
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c. HOST FICE |
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Normal Academic Progression Standard |
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Curr GPA: |
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CUM: |
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Curr GPA: |
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CGPA: |
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b. Credits toward degree Comp to date: |
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Term: |
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Term: |
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c. Transfer Credits accepted: |
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Curr GPA: |
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CUM: |
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Curr GPA: |
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CGPA: |
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d. Remaining for Degree: |
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Term: |
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Term: |
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e. Number of authorized S/Qs: |
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Curr GPA: |
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CUM: |
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Curr GPA: |
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CGPA: |
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7.TERM, YEAR, COURSE NUMBER, COURSE TITLE, COURSE CREDIT HOURS, CREDITS THAT COUNT TOWARDS ACADEMIC DEGREE, AND ACHIEVED GRADES.
a.
Term: |
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Year: |
No. |
Course Title |
Hrs. Cts. Grd. |
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Total Term Hours:
d.
Term: |
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Year: |
No. |
Course Title |
Hrs. Cts. Grd. |
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Total Term Hours:
b.
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Term: |
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Year: |
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No. |
Course Title |
Hrs. Cts. Grd. |
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Total Term Hours:
e.
Term: |
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Year: |
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No. |
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Course Title |
Hrs. Cts. Grd. |
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Total Term Hours:
c.
Term: |
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Year: |
No. |
Course Title |
Hrs. Cts. Grd. |
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Total Term Hours:
f.
Term: |
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Year: |
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No. |
Course Title |
Hrs. Cts. Grd. |
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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: |
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TERM 7: |
TERM 5: |
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TERM 8: |
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TERM 6: |
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TERM 9: |
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USACC Form
Page 1 of 3
PLANNED ACADEMIC PROGRAM WORKSHEET
For use of this form, see USACC Pam
7.TERM, YEAR, COURSE NUMBER, COURSE TITLE, COURSE CREDIT HOURS, CREDITS THAT COUNT TOWARDS ACADEMIC DEGREE, AND ACHIEVED GRADES. (CONTINUED)
g.
Term: |
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Year: |
No. |
Course Title |
Hrs. Cts. Grd. |
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Total Term Hours:
h.
Term: |
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Year: |
No. |
Course Title |
Hrs. Cts. Grd. |
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Total Term Hours:
i.
Term: |
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Year: |
No. |
Course Title |
Hrs. Cts. Grd. |
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Total Term Hours:
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j. |
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k. |
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l. |
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Term: |
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Year: |
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Term: |
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Year: |
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Term: |
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Year: |
No. |
Course Title |
Hrs. Cts. Grd. |
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No. |
Course Title |
Hrs. Cts. Grd. |
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No. |
Course Title |
Hrs. Cts. Grd. |
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Total Term Hours: |
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Total Term Hours: |
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Total Term Hours: |
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m. |
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n. |
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o. |
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Term: |
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Year: |
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Term: |
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Year: |
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Term: |
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Year: |
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No. |
Course Title |
Hrs. |
Cts. |
Grd. |
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No. |
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Course Title |
Hrs. |
Cts. |
Grd. |
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No. |
Course Title |
Hrs. |
Cts. |
Grd. |
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Total Term Hours: |
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Total Term Hours: |
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Total Term Hours: |
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9. REVIEW: All of the above courses are required (as minimum) for the completion of the degree: |
YES |
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NO (if no, list exceptions on reverside of this form). |
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Completion should result in |
degree, during (Month, Year): |
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10. |
SIGNATURE OF STUDENT: |
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11. |
DATE: (MM/DD/YYYY) |
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12. |
SIGNATURE OF REGISTRAR AND EXAMINER OF CREDENTIALS (OR OTHER INSTITUTION CERTIFYING OFFICIAL): |
13. |
DATE: (MM/DD/YYYY) |
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USACC Form |
Page 2 of 3 |
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PLANNED ACADEMIC PROGRAM WORKSHEET |
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For use of this form, see USACC Pam |
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STATEMENT OF UNDERSTANDING |
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We, the undersigned, hereby declare that the program outlined on the worksheet (on the reverse side of this statement) that |
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Cadet |
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is about to under take a formally structured program approved by |
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(FULL NAME, Last, First, MI) |
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(Name of University or College) |
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designed to meet the requirments of a |
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degree; that the degree to be attained is the culmination of an |
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(Type of Degree) |
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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 |
Page 3 of 3 |
Common mistakes
Filling out the 104 R form can be a straightforward process, but many applicants make common mistakes that can lead to delays or complications. One frequent error is not providing complete or accurate personal information. The form requires the student’s full name, academic major, and other identifying details. Omitting any of this information can result in processing issues. Ensure that every section is filled out correctly to avoid unnecessary back-and-forth with the administration.
Another mistake is failing to check the academic requirements thoroughly. Each student must understand their degree program's specific requirements. This includes knowing the number of credit hours needed and the courses that count towards their degree. If this information is not accurately reflected in the form, it may hinder the student’s progress and eligibility in the ROTC program. Always verify that the listed courses align with the academic plan.
Many students overlook the importance of updating their GPA and credit hours accurately. The form asks for current and cumulative GPAs, as well as credit hours completed. If these figures are incorrect, it can misrepresent the student's academic standing. Double-check these numbers before submission to ensure they reflect the most current information. An inaccurate GPA could lead to misunderstandings regarding eligibility for the program.
In addition, neglecting to sign and date the form can create significant issues. Both the student and the registrar or certifying official must sign the document for it to be valid. Without these signatures, the form may be considered incomplete. Always remember to sign and date each section where required to ensure the form is processed smoothly.
Lastly, failing to review the entire form before submission is a common pitfall. Students often rush through the process and miss critical details. Take the time to review the completed form carefully. Look for any discrepancies or missing information. A thorough review can save time and prevent potential delays in the ROTC application process.
Dos and Don'ts
When filling out the 104 R form, it is essential to follow certain guidelines to ensure accuracy and compliance. Here are ten things to do and avoid:
- Do provide your full name as it appears on official documents.
- Do clearly indicate your academic major and CIP code.
- Do use the correct format for dates (MM/DD/YYYY).
- Do ensure your GPA is accurate and reflects the most recent calculations.
- Do list all courses taken, including course numbers and grades.
- Don't leave any sections blank; fill out all required fields.
- Don't use abbreviations that may not be understood by the reviewing authority.
- Don't forget to sign and date the form where indicated.
- Don't include unnecessary personal information that is not requested.
- Don't submit the form without reviewing it for errors or omissions.
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