Addendum to the 2011-2012 High School Handbook
Jackson County Schools
Mississippi Basic Diploma Application
Student information:
Name
____________________________
Date ______________________
MSIS #
____________________________
Age _____________________
Year Entered 9th Grade:_________________
Current Grade:
_______
SATP Test Passed:
GPA:
_______
Current Credits:
_______
(Circle all applicable)
Algebra I, Biology I, English MC, English WR, U.S. History
Core Curriculum Completed:
_____4 credits of English
English I
English II
English Electives (2 credits)
______________________
______________________
_____½ credit of Health
Comprehensive Health (½ credit)
or
Family Individual Health (½ credit)
_____½ credit Physical Education
_____4 credits of Math
Algebra I
Math Electives (3 credits)
_____________________
_____________________
_____________________
_____1 credit Business & Technology
Technology Foundations
or
Computer Apps & Keyboarding
_____3 credits of Science
Biology I
Science Electives (2 credits)
______________________
______________________
_____4 credits of Electives
World Geography (½ credit)
______________________
______________________
______________________
______________________
_____1 credit of Fine Arts
_____3 credits of Social Studies
World History
U.S. History
MS Studies (½ credit)
U.S. Government (½ credit)
Student's Post-secondary Plans:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Recommended by Teacher/Counselor: _____________________
Parental Signature for Approval of MS Basic Diploma
Signature of Student Applicant for MS Basic Diploma
Counselor Verification of Criteria for Participation
Counselor/Administrator Verification of Parental Approval
_____________________________
Signature
____________________________
Signature
______________________________
Signature
______________________________
Signature
Committee Met Date:_________________
Committee Members:
___________________________________
(Principal)
___________________________________
(Signature)
___________________________________
(Counselor)
___________________________________
(Signature)
___________________________________
(TST Interventionist)
__________________________________
(Signature)
___________________________________
(Teacher)
___________________________________
(Signature)
___________________________________
(SPED, if applicable)
___________________________________
(Signature)
Jackson County School District
PARENTAL / STUDENT AGREEMENT
For the
Mississippi Basic Diploma Career Pathway
I understand that the Mississippi Basic Diploma is a diploma offered by Mississippi Department of
Education which requires only 21 credits for graduation.
I understand that Mississippi Basic Diploma requires specific credits for graduation that meet the
Mississippi Department of Education's basic requirements for graduation and does not meet all IHL
college prep requirements; however, it does meet requirements for admission to any Mississippi
community college.
I understand that with a Mississippi Basic Diploma, I will be eligible for participation in the Graduation
Ceremonies, but my GPA will not be considered in regards to class rank for walking order. My position
for Graduation will be with those graduating alphabetically. I will have a GPA printed on my transcript. I
will be eligible for any awards at the Senior Awards Ceremony in May if applicable.
I, the undersigned, agree to the terms of the Mississippi Basic Diploma Career Pathway requirements.
____________________________
Student Signature
________________________________
Date
I, the parent of the above named student, do hereby give my consent for my child to participate in the
Mississippi Basic Diploma Career Pathway. I agree with the above stated terms of the program.
_____________________________
Parent Signature
_________________________________
Date