Code No. 503.7E1
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:
