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