EDUCATIONAL PROGRAM

Series 600

 

Policy Title:            Report of Student Disclosure of Identity

Code No.              522E1

 

Dear Parent/Guardian _________________________________,

 

 

This letter is to inform you that your student (student's name listed on registration)

 

________________________________ 

 

has made a request of a licensed employee to (check all that apply):

 

 

______  make an accommodation that is intended to affirm the student's gender identity as follows:

 

_____________________________________________________________________________

 

_____________________________________________________________________________

 

 

 

 

_______ use a name, pronoun or gender identity that is different from the name, pronoun and/or gender identity listed on the student's school registration forms.  The name, pronoun, or gender identity requested is _____________________________________________________________________________

 

 

 

If you would like to amend the student's registration paperwork to permit the student's requested accommodation and/or include the use of the above-referenced name/pronoun/gender identity, please complete the attached form and return it to the district administration office.

 

 

Sincerely,

 

 

 

____________________________________________________________

 

Administrator

 

 

 

________________________                       

Date                                                                                   

 

 

Date of Adoption/Review/Revision:           

August 2023