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503.7E1 Exhibit 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. 



_____________________________________                                     __________________ 
Administrator                                                                                           Date

Adopted:             08/07/2023
  • Series 500 Students