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: ____________
