www.genderspecLrum.org 310-788-4412 lnfo[genderspecLrum.

org




! #$%&'()%*'+, !
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School/ulsLrlcL 1oday's uaLe
SLudenL's referred name Legal name
SLudenL's Cender Asslgned Sex aL 8lrLh SLudenL Crade Level
uaLe of blrLh Slbllng(s)
arenL(s)/Cuardlan(s)/Careglver(s) and relaLlon Lo sLudenL


MeeLlng parLlclpanLs:

-----------------------------------------------------------------------------------
#345678496:;69<= 2>6?:#< :47 76/#;3/@>8
Pow publlc or prlvaLe wlll lnformaLlon abouL Lhls sLudenL's gender be (check all LhaL apply)?
____ ulsLrlcL sLaff wlll be aware (SuperlnLendenL, SLudenL SupporL Servlces, ulsLrlcL sychologlsL, eLc.)
Speclfy Lhe adulL sLaff members who wlll be aware of sLudenL's gender:

____ SlLe level leadershlp/admlnlsLraLlon wlll know (rlnclpal, head of school, counselor, eLc.)
Speclfy Lhe adulL sLaff members who wlll be aware of sLudenL's gender:

____ 1eachers and/or oLher school sLaff wlll know
Speclfy Lhe adulL sLaff members who wlll be aware of sLudenL's gender:

____ SLudenL wlll noL be openly ouL," buL some sLudenLs are aware of Lhe sLudenL's gender
Speclfy Lhe sLudenLs who are aware of sLudenL's gender:

____ SLudenL ls open wlLh oLhers (adulLs and peers) abouL gender
____ CLher - descrlbe:

lf Lhe sLudenL has asserLed a degree of prlvacy, whaL are expecLaLlons of Lhe lnsLlLuLlon lf LhaL prlvacy ls
compromlsed? Pow wlll a Leacher/sLaff member respond Lo quesLlons abouL Lhe sLudenL's gender from:

CLher sLudenLs?

SLaff members?

arenLs/communlLy?



www.genderspecLrum.org 310-788-4412 lnfo[genderspecLrum.org




4:A8/= 2>343@4/= :47 /9@7849 >8#3>7/
name/gender marker enLered lnLo Lhe SLudenL lnformaLlon SysLem
WhaL, lf any, ad[usLmenLs can be made Lo proLecL Lhls sLudenL's prlvacy?


name Lo be used when referrlng Lo Lhe sLudenL ronouns
Pow wlll lnsLances be handled ln whlch Lhe lncorrecL name or pronoun are used?

Pow wlll Lhe sLudenL's prlvacy be accounLed for and malnLalned ln Lhe followlng slLuaLlons:
uurlng reglsLraLlon
CompleLlng enrollmenL
1aklng aLLendance
Asslgnlng grades
Cfflclal School-home communlcaLlon
unofflclal School-home communlcaLlon (1A/oLher)
AfLer-school programs
School phoLos
WlLh subsLlLuLe Leachers
CuLslde dlsLrlcL personnel or provlders
Summons Lo offlce
?earbooks
SLudenL lu/llbrary cards
osLed llsLs
ulsLrlbuLlon of LexLs or oLher school supplles
AsslgnmenL of l1 accounLs
SLandardlzed LesLs
Lunch llnes
A announcemenLs
WhaL are some oLher ways Lhe school needs Lo anLlclpaLe lnformaLlon abouL Lhls sLudenL's preferred name and
gender marker poLenLlally belng compromlsed? Pow wlll Lhese be handled?





www.genderspecLrum.org 310-788-4412 lnfo[genderspecLrum.org




@/8 35 5:#6;6968/
SLudenL wlll use Lhe followlng resLroom(s) on campus
SLudenL wlll change cloLhes ln Lhe followlng place(s)
WhaL are Lhe expecLaLlons regardlng Lhe use of faclllLles for any class Lrlps?

WhaL are Lhe expecLaLlons regardlng roomlng for any overnlghL Lrlps?

Are Lhere any quesLlons or concerns abouL Lhe sLudenL's access Lo faclllLles on campus?



/9@7849 /:589<
Who wlll be Lhe sLudenL's go Lo adulL" on campus?
lf Lhls person ls noL avallable, whaL should sLudenL do?
WhaL, lf any, wlll be Lhe process for perlodlcally checklng ln wlLh Lhe sLudenL and/or famlly?

WhaL are expecLaLlons ln Lhe evenL Lhe sLudenL ls feellng unsafe:
uurlng class
Cn Lhe yard
ln Lhe halls
CLher
CLher SafeLy concerns:



8B9>:C#@>>6#@;:> :#96?6968/
ln whaL exLra-currlcular programs or acLlvlLles wlll Lhe sLudenL be parLlclpaLlng?

WhaL conslderaLlons musL be made for Lhese?




www.genderspecLrum.org 310-788-4412 lnfo[genderspecLrum.org




39D8> #34/678>:9634/
Are Lhere any speclflc soclal dynamlcs wlLh oLher sLudenLs, famllles or sLaff members LhaL need Lo be
dlscussed or accounLed for?


WhaL Lralnlng wlll Lhe school engage ln Lo bulld capaclLy for worklng wlLh gender-expanslve sLudenLs?


uoes Lhe school have a dress code? Pow wlll Lhls be handled?

Are Lhere parLlcular lessons, unlLs, conLenL or oLher acLlvlLles Lo conslder (growLh and developmenL,
soclal [usLlce unlLs, name pro[ecLs, dance lnsLrucLlon, rlde evenLs, eLc. school dances)?


Are Lhere any oLher quesLlons, concerns or lssues we need Lo dlscuss?






WhaL are speclflc follow-ups or acLlon lLems emerglng from Lhls meeLlng?



uaLe/1lme of nexL meeLlng or check-ln