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Intake Form: Supporting Student Gender Identity

About this Form

Form number: 560-80

Audience:  MCPS Staff

Last revised: November 2019

Instructions: The school administrator, counselor, or psychologist should complete this form with the student. Parents/guardians may be involved if the student states that they are aware of and supportive of the student’s gender identity. This form should be kept in a secure, confidential location. See distribution information on Page 2. This form is not to be kept in the student’s cumulative or confidential folders. All plans should be evaluated on an ongoing basis and revised as needed.

Distribution:

Copy 1/School Confidential folder (in principal’s office)
Copy 2/ Student Welfare and Compliance Unit, via scan to COS-StudentWelfare@mcpsmd.org, or via pony to CESC, Room 162, in a envelope marked confidential

Adobe PDF Intake Form: Supporting Student Gender Identity449 KEnglish
Adobe PDF Formulario de Inscripción: Apoyo a la Identidad de Género de los Estudiantes446 KSpanish
Adobe PDF Formulaire d'admission : Soutien à l'identité de genre des élèves445 KFrench
Adobe PDF MẫuThâu Nhận: Hỗ Trợ Nhận Dạng Giới Tính của Học Sinh510 KVietnamese
Adobe PDF 登記表: 支持學生的性別認同602 KChinese
Adobe PDF 접수 양식: 학생 성 정체성 지원478 KKorean
Adobe PDF የተማሪ ጾታ መለያ መቀበያ ቅጽ፦473 KAmharic

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