Appendix H

Individual Prescription for Instruction (IPI)

for SASC and GED Pathway Students

Name: ______ Entrance Date: ______

Originating School:______

HighSchool Attending:______

Diploma or Certifications:  State-approved Skills Certificate (SASC Pathway)

Louisiana High School Equivalency Diploma (GED Pathway)

Postsecondary Plans:Technical CollegeTechnical Training

Community CollegeEmployment

MilitaryOther ______

Year 1 / Year 2
Academic Component
List courses: / Academic Component
List courses:
Skills Component
List courses: / Skills Component
List courses:
Electives
List courses: / Electives
List courses:
Other
List comments: / Other
List comments:
Assessments
List tests/dates: / Assessments
List tests/dates:
For SASC students only:
Career Cluster__ Agricultural, Food & Natural Resources __ Education and Training __ Human Services __ Government and Public Administration__ Arts, A/V Technology & Communication __ Finance __ Information Technology __ Marketing, Sales & Services__ Architecture and Construction __ Health Science __ Law, Public Safety & Security __ Science, Technology, Engineering & Math__ Business, Management & Administration __ Hospitality and Tourism __ Manufacturing __ Transportation, Distribution & Logistic Service / For SASC students only:
Career Cluster__ Agricultural, Food & Natural Resources __ Education and Training __ Human Services __ Government and Public Administration__ Arts, A/V Technology & Communication __ Finance __ Information Technology __ Marketing, Sales & Services__ Architecture and Construction __ Health Science __ Law, Public Safety & Security __ Science, Technology, Engineering & Math__ Business, Management & Administration __ Hospitality and Tourism __ Manufacturing __ Transportation, Distribution & Logistic Service
For GED students only:
Official Practice GED Test Scores
LA-W ____ LA-R ____ SCI ____ SS____ Math____ Average____
GED Test Scores
LA-W ____ LA-R ____ SCI ____ SS____ Math____ Average_____ / For GED students only:
Official Practice GED Test Scores
LA-W ____ LA-R ____ SCI ____ SS____ Math____ Average____
GED Test Scores
LA-W ____ LA-R ____ SCI ____ SS____ Math____ Average_____

I have read and been informed of all the above information and agree that participation in this exiting pathway is in the student's best interest for the continuation of his/her educational pursuit and future educational plans. Further, I have in no way been coerced or persuaded to enter into this agreement.

Student______Date______

Parent/Guardian______Date______

Staff Verification: I acknowledge that this student and his/her parent(s)/guardian(s) have been appropriately counseled about the implications of this decision.

Student______Date______

Counselor/Advisor______Date______