503.07E1: Report Student Disclosure Identity

REPORT OF STUDENT DISCLOSURE OF IDENTITY

 

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

 

 

ADOPTED: August 14, 2023

REVIEWED:

REVISED:

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