503.07E1 STUDENT DISCLOSURE OF IDENTITY - REPORT OF STUDENT DISCLOSURE OF IDENTITY

TIPTON COMMUNITY SCHOOL DISTRICT

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

 

Approved:  08/14/2023                 Reviewed:  ____________                   Revised:  ____________