Spreadsheet: 00f6dac2-271d-49fb-9829-e16e90b9603e
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PLANNED ACADEMIC PROGRAM WORKSHEET | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13 | Unnamed: 14 | Unnamed: 15 | Unnamed: 16 | Unnamed: 17 | Unnamed: 18 | Unnamed: 19 | Unnamed: 20 | Unnamed: 21 | Unnamed: 22 | Unnamed: 23 | Unnamed: 24
For use of this form, see [NAME] 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 [NAME] 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 prjected 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 |  |  |  |  |  | 3.  AS OF DATE (MM/DD/YYYY) (Date of form preparation)
4.  INSTITUTION OF ATTENDANCE AND IDENTIFICATION |  |  |  |  |  |  | 5.  CREDIT HOURS |  |  |  |  |  | 6.  GRADE POINT AVERAGE (GPA)
[NAME]: |  |  |  |  |  |  | a.  Total required for degree: |  |  |  |  |  | Term: |  |  |  |  |  | Term:
b.  Identification (Check one): |  |  | Host |  |  |  | (1)  ROTC Hours that do not count: |  |  |  |  |  | Curr GPA: |  |  | CUM: |  |  | Curr GPA: |  |  | CUM:
 |  |  | Extension Center |  |  |  | (2)  Total Hours Rqd for NAPS: |  |  | 0 |  |  | Term: |  |  |  |  |  | Term:
 |  |  | Cross-Enrolled |  |  |  | Normal Academic Progression |  |  | 0 |  |  | Curr GPA: |  |  | CUM: |  |  | Curr GPA: |  |  | CUM:
c.  If attendance is at an extension center or cross-enrolled school, |  |  |  |  |  |  | [NAME] accepted: |  |  |  |  |  | Term: |  |  |  |  |  | Term:
list the name of the Host Institution: |  |  |  |  |  |  | c.  Credits toward degree Comp to date: |  |  |  |  |  | Curr GPA: |  |  | CUM: |  |  | Curr GPA: |  |  | CUM:
 |  |  |  |  |  |  | d.  Reamining for Degree: |  |  | 0 |  |  | Term: |  |  |  |  |  | Term:
 |  |  |  |  |  |  | e.  Number of authorized semesters: |  |  |  |  |  | Curr GPA: |  |  | CUM: |  |  | Curr GPA: |  |  | CUM:
 |  |  |  |  |  |  |  |  |  |  |  |  | Term: |  |  |  |  |  | Term:
 |  |  |  |  |  |  |  |  |  |  |  |  | Curr GPA: |  |  | CUM: |  |  | Curr GPA: |  |  | CUM:
7. | TERM, YEAR, COURSE NUMBER, COURSE TITLE, COURSE CREDIT HOURS, CREDITS THAT COUNT TOWARDS ACADEMIC DEGREE, AND ACHIEVED GRADES.
 |  | a. |  |  |  |  |  | b. |  |  |  |  |  |  | c.
 | 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: | 0 | 0 |  |  |  | Total Term Hours: | 0 | 0 |  |  |  |  | Total Term Hours: |  |  |  |  |  | 0 | 0
 |  | d. |  |  |  |  |  | e. |  |  |  |  |  |  | f.
 | 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: | 0 | 0 |  |  |  | Total Term Hours: | 0 | 0 |  |  |  |  | Total Term Hours: |  |  |  |  |  | 0 | 0
8.  STUDENT INITIALS & DATE: |  |  | TERM  1: |  |  |  |  |  | TERM  4: |  |  |  |  |  |  |  |  | TERM  7:
(Have the student initial and date beside each |  |  | TERM 2: |  |  |  |  |  | TERM  5: |  |  |  |  |  |  |  |  | TERM  8:
term to indicate they have been counseled) |  |  | TERM 3: |  |  |  |  |  | TERM  6: |  |  |  |  |  |  |  |  | TERM  9:
CC Form 104-R, DEC 03 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Page 1 of 3