Printable 104 R Form

When filling out and using the 104 R form, consider the following key takeaways:

• Understand the Purpose: The 104 R form is designed to provide essential information for managing students in the Army Senior ROTC program. It helps determine if applicants meet the necessary academic requirements for commissioning.
• Provide Accurate Information: Ensure that all fields, including academic major, credit hours, and GPA, are filled out accurately. Inaccurate information can affect eligibility for the program.
• Voluntary Disclosure: Remember that providing information on this form is voluntary. However, omitting details may impact your acceptance or continuation in the ROTC program.
• Signature Requirements: Both the student and the certifying official must sign the form. This ensures that the academic plan is understood and approved by all parties involved.

What is the purpose of the 104 R form?

The 104 R form, also known as the Planned Academic Program Worksheet, serves to collect essential information about a student's academic trajectory within the Army Senior ROTC program. It helps determine whether students meet the requirements for commissioning in the Army and ensures they are on track to complete their degrees in the allotted time.

Who needs to fill out the 104 R form?

This form is typically filled out by students participating in the Army ROTC program. It is particularly important for those who are nearing the completion of their academic programs and need to provide a clear outline of their remaining coursework and credits.

What information is required on the 104 R form?

Students must provide personal details such as their name, academic major, and the name of their academic institution. Additionally, they need to list their current GPA, credit hours, and a detailed account of the courses they have taken or plan to take, including course titles, credit hours, and grades achieved.

How does the 104 R form impact my ROTC scholarship?

If you are a recipient of an ROTC scholarship, the 104 R form plays a crucial role in maintaining your scholarship eligibility. It outlines your academic progress and verifies that you are meeting the necessary requirements to continue receiving financial support for your education.

What happens if I do not provide the information requested on the 104 R form?

Failing to provide the necessary information can affect your eligibility for the ROTC program. Since the form helps determine your academic standing and progress, incomplete submissions may lead to delays in processing your scholarship or even jeopardize your place in the program.

Is the information on the 104 R form confidential?

Yes, the information provided on the 104 R form is protected under the Privacy Act of 1974. This means that it is used solely for the purpose of administering the ROTC program and will not be disclosed without your consent, except as required by law.

What should I do if my academic plan changes?

If your academic plan changes, it is essential to update the 104 R form accordingly. This ensures that your academic progress is accurately reflected and that you remain compliant with ROTC requirements. Consult with your academic advisor or ROTC coordinator for guidance on how to make these updates.

How often do I need to submit the 104 R form?

The 104 R form should be submitted at least once a year, or whenever there are significant changes to your academic plan. Regular updates help maintain accurate records and ensure that you are on track to meet your degree requirements.

Who signs the 104 R form?

The form requires signatures from both the student and a certifying official, such as a registrar or academic advisor. These signatures confirm that the information provided is accurate and that the student has been counseled regarding their academic progress.

Where can I find the 104 R form?

The 104 R form can typically be obtained from your ROTC program office or downloaded from the official Army ROTC website. Make sure to use the most current version of the form to ensure compliance with all requirements.

104 R - Usage Instruction

Completing the 104 R form is essential for providing a detailed academic plan as part of the Army Senior ROTC program. This form requires specific information about the student's academic progress, including courses taken and credits earned. Follow these steps to fill out the form accurately.

1. Enter Student Information: Fill in the student’s name (last, first, middle initial) in the designated field.
2. Academic Major: Specify the student’s academic major.
3. CIP Code: Provide the Classification of Instructional Programs (CIP) code for the major.
4. Date of Form Preparation: Enter the date in MM/DD/YYYY format.
5. Academic School: Indicate the name of the academic institution.
6. Credit Hours: Record the total credit hours required for the degree.
7. Grade Point Average (GPA): Fill in the current GPA and cumulative GPA. Choose whether the student is on a semester or quarter system.
8. Course Information: For each term, list the year, course number, course title, credit hours, credits that count towards the degree, and achieved grades. Repeat for all relevant terms.
9. Student Initials & Date: Have the student initial and date beside each term to confirm counseling.
10. Review Requirements: Indicate whether all listed courses are required for the completion of the degree by selecting yes or no. If no, provide exceptions on the reverse side.
11. Student Signature: The student must sign the form.
12. Date: Enter the date of the student’s signature in MM/DD/YYYY format.
13. Registrar Signature: Obtain the signature of the registrar or certifying official.
14. Registrar Date: Record the date of the registrar’s signature in MM/DD/YYYY format.
15. Statement of Understanding: Ensure the student and professor of military science sign and date the statement confirming the program details.