High School/International Baccalaureate

Academically and/or Intellectually Gifted

Differentiated Education Plan

Date Last Updated
Name:
NC Wise #:
School Choice: / West Iredell HighSouth Iredell HighNorth Iredell HighLake Norman HighStatesville HighMt Mourne IBNorthview IBCCTLVPAC
Address:
City/State/Zip Code: / ,
Phone #: / --
Alternate Phone #: / --
Grade:

9th Grade Information:

**Please fill in the COMPLETE COURSE name and level. Be specific. (For example: AP Biology or Honors English 1)

Courses:

Fall Semester Courses:
Spring Semester Courses:

Extracurricular/Enrichment:

Clubs/Organizations:

Community Service:

Service Opportunity / Hours of Service
Total Hours Combined:

Athletics:

Leadership:

Positions of responsibility within a club, society or sports team in school; place on governing body, similar positions held in the wider community.

Goals Section:

Assessment Goals; as appropriate for post secondary plans

How will you achieve these goals?

NCSSM
NC School for the Arts
Duke TIP
Governor’s School
Summer Camp
Other:

Signatures:

Student: / Date:
Parent: / Date:
Principal: / Date:
AIGSchool Coordinator: / Date:

10th Grade Information:

**Please fill in the COMPLETE COURSE name and level. Be specific. (For example: AP Biology or Honors English 1)

Courses:

Fall Semester Courses:
Spring Semester Courses:

Extracurricular/Enrichment:

Clubs/Organizations:

Community Service:

Service Opportunity / Hours of Service
Total Hours Combined:

Athletics:

Leadership:

Positions of responsibility within a club, society or sports team in school; place on governing body, similar positions held in the wider community.

Goals Section:

Assessment Goals; as appropriate for post secondary plans

How will you achieve these goals?

NCSSM
NC School for the Arts
Duke TIP
Governor’s School
Summer Camp
Other:

Signatures:

Student: / Date:
Parent: / Date:
Principal: / Date:
AIGSchool Coordinator: / Date:

11th Grade Information:

**Please fill in the COMPLETE COURSE name and level. Be specific. (For example: AP Biology or Honors English 1)

Courses:

Fall Semester Courses:
Spring Semester Courses:

Extracurricular/Enrichment:

Clubs/Organizations:

Community Service:

Service Opportunity / Hours of Service
Total Hours Combined:

Athletics:

Leadership:

Positions of responsibility within a club, society or sports team in school; place on governing body, similar positions held in the wider community.

Goals Section:

Assessment Goals; as appropriate for post secondary plans

How will you achieve these goals?

NCSSM
NC School for the Arts
Duke TIP
Governor’s School
Summer Camp
Other:

Signatures:

Student: / Date:
Parent: / Date:
Principal: / Date:
AIGSchool Coordinator: / Date:

12th Grade Information:

**Please fill in the COMPLETE COURSE name and level. Be specific. (For example: AP Biology or Honors English 1)

Courses:

Fall Semester Courses:
Spring Semester Courses:

Extracurricular/Enrichment:

Clubs/Organizations:

Community Service:

Service Opportunity / Hours of Service
Total Hours Combined:

Athletics:

Leadership:

Positions of responsibility within a club, society or sports team in school; place on governing body, similar positions held in the wider community.

Goals Section:

Assessment Goals; as appropriate for post secondary plans

How will you achieve these goals?

NCSSM
NC School for the Arts
Duke TIP
Governor’s School
Summer Camp
Other:

Signatures:

Student: / Date:
Parent: / Date:
Principal: / Date:
AIGSchool Coordinator: / Date: