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Question	Answer
Form Name	104 R Form
Form Length	3 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	45 sec
Other names	cc form 104 r, 104r form, 104 r form, 104r pdf

12

Form Preview 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:

Term:

a. IDENTIFICATION (Check one):

Host

Curr GPA:

CUM:

Curr GPA:

CGPA:

Extension Center

a. Total required for degree:

1

Term:

Term:

Cross-Enrolled

(1) ROTC Hours that do not count:

Curr GPA:

CUM:

Curr GPA:

CGPA:

(2) Total Hours Rqd for NAPS:

Term:

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:

Term:

c. Transfer Credits accepted:

Curr GPA:

CUM:

Curr GPA:

CGPA:

d. Remaining for Degree:

Term:

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.

a.

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

d.

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

b.

	Term:		Year:
	No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

e.

Term:			Year:
No.		Course Title	Hrs. Cts. Grd.
No.		Course Title	Hrs. Cts. Grd.

Total Term Hours:

c.

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

f.

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)

g.

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

h.

Term:		Year:
No.	Course Title	Hrs. Cts. Grd.

Total Term Hours:

i.

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:

Total Term Hours:

Total Term Hours:

m.

n.

o.

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:

Total Term Hours:

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

How to Edit 104 R Form Online for Free

The entire process of filling out the cc 104 r is very quick. We ensured our tool is easy to utilize and helps fill in almost any form in no time. Have a look at a couple of steps you have to take:

Step 1: Press the orange "Get Form Now" button on the following page.

Step 2: Once you've accessed the cc 104 r edit page, you'll discover all actions it is possible to use concerning your template at the upper menu.

These particular segments are included in the PDF file you'll be filling in.

104r pdf fields to fill out

The software will require you to fill in the Total Term Hours, Total Term Hours, Term No, Course Title, Year Hrs Cts Grd, Term No, Course Title, Year Hrs Cts Grd, Term No, Total Term Hours, Course Title, Year Cts, Grd, Hrs, and Total Term Hours section.

Completing 104r pdf step 2

You may be expected to write down the details to help the platform fill in the field TERM YEAR COURSE NUMBER COURSE, Term No, Course Title, Year Hrs Cts Grd, Term No, Course Title, Hrs Cts, Grd, Year, Term No, Course Title, Year Hrs Cts Grd, Total Term Hours, Total Term Hours, and Total Term Hours.

Finishing 104r pdf stage 3

The Total Term Hours, Total Term Hours, Total Term Hours, REVIEW All of the above courses, Yes, No if no list exceptions on, Completion should result in, SIGNATURE OF STUDENT, degree during Month Year, DATE MMDDYYYY, SIGNATURE OF REGISTRAR AND, DATE MMDDYYYY, USACC Form R SEP, and Page of section is going to be place to insert the rights and obligations of both parties.

part 4 to finishing 104r pdf

Finalize by reviewing the next fields and typing in the proper data: We the undersigned hereby declare, Cadet, FULL NAME Last First MI, is about to under take a formally, Name of University or College, designed to meet the requirments, degree that the degree to be, Type of Degree, undergraduate college program of, discipline requirements or to, and participant the scholarship will.

Filling in 104r pdf part 5

Step 3: Select the button "Done". Your PDF document is available to be transferred. You will be able obtain it to your pc or send it by email.

Step 4: Make as much as two or three copies of your form to remain away from any sort of future challenges.

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