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Dear Parent/Guardian,
This letter is to inform you that your student (Insert student's name as listed on school registration form) 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 (Refer to Policy 504.14-E2) and return it to the Student Support Services office (3556 Winslow Road, Marion, IA 52302).
Sincerely,
Administrator's Signature: _______________________________
Building: ___________________________________________
Date: ______________________________________________
Adopted: 8/23
Revised: (/24
Related Policy: 504.14; 504.14-E2
Legal Reference (Code of Iowa): SF496
IASB Reference: 503.07-E(1)