Jerome Joint School District No. 261

STUDENTS 3281F

Gender Identity and Sexual Orientation Gender Support Plan

Name of Student: ____________________________Grade:_______________________________

School:____________________________________ Date of Birth:_________________________

Print Name of Parent/Guardian:______________________________________________________ 

Relationship to Student: ____________________________________________________________

Guardian/Parent Phone Number:_____________________________________________________

Guardian/Parent Email:_____________________________________________________________

Please Indicate the Preferred Name:__________________________________________________

Optional Please indicate the pronouns your child prefers to use at school:

• He/Him/His

• She/Her/Hers

• They/Them/Theirs

• Other (Please specify)__________________________________________________________

Parental Consent:

I, the undersigned, acknowledge that I have discussed with my child their preferred pronouns, and I consent to the school staff and teachers addressing my child by these pronouns in all school-related activities, including but not limited to classroom settings, school records, and extracurricular activities.

I understand that this information will be kept confidential and used only for the purpose of fostering an inclusive and supportive school environment.

Guardian/Parent Signature:______________________________________ Date:_______________

Cross Reference:

3281        Gender Identity and Sexual Orientation

3281P      Gender Identity and Sexual Orientation Administrative Procedure

Policy History:

Adopted on: 07/19/2022

Revised on: 05/27/2025