CONFIDENTIAL - Gender Support Plan

The purpose of this document is to create shared understandings about the ways in which the student’s authentic gender will be accounted for and supported at school. School staff, caregivers and the student should work together to complete this document. Ideally, each will spend time completing the various sections to the best of their ability and then come together to review sections and confirm shared agreements about using the plan. Please note that there is a separate document, the Gender Communication Plan for a student formally communicating information about their gender status at school.

INSTRUCTIONS:

The online Gender Support Plan allows you and your team to save and resume filling out the plan at any time. This allows you to share the plan among team members as needed. When you “save and resume” the form, you will be asked for an email and password. When those are entered, you will receive an email with a link to continue the form. The team leader can then forward that email and password to any team member, who can sign in (using the team leader’s email address) and continue filling out the form.

When the Gender Support Plan is finished, click "Review" and you will be directed to a page with all of your responses. From this page you may edit, download and/or print the completed plan. YOU DO NOT NEED TO CLICK "CONFIRM" TO SUBMIT YOUR PLAN. IF YOU DO CLICK CONFIRM; YOU CAN IGNORE THE MESSAGE YOU WILL RECEIVE WHEN YOU "REVIEW" THE PLAN. USE YOUR BROWSER'S BACK BUTTON TO GO BACK TO YOUR COMPLETED FORM.

Student Information

Date

School/District

Name Student Uses

Name on Student's Birth Certificate

Student's Gender Identity

Student's Assigned Sex at Birth

Student's Date of Birth

Student's Grade Level

Parent(s), Guardian(s) and/or Caregiver(s) Information

Name

Relation to Student

Sibling Information

Name

Grade Level

Participants at today's meeting

Parent/Guardian Involvement

Are the parent(s)/guardian(s) aware of the student's gender status?

YesNo

On a scale of 1-10, where 1 is "not at all supportive" and 10 is "highly supportive," rank the parent(s)/guardian(s) support level:

If support level is low, what considerations must be accounted for in implementing this plan?

Student Safety

Who will be the student's "go to" adults on campus?

If these people aren't unavailable, what should the student do?

What, if any, will be the process for periodically checking in with the student and/or family?

What are the expectations in the event the student is feeling unsafe and how should they signal their need for help...

...in class?

...on the yard?

...in hallways?

...other?

What should the student's parents do if they are concerned about how others are treating the student at school?

Other safety concerns/questions:

Page 2

Privacy: Names, Pronouns and Student Records

Name to be used when referring to the student

Student's Pronouns

Name listed on student's identity documents

Gender marker listed on identity documents

Name entered into the Student Information System

Gender marker entered into the Student Information System (SIS)

If needed, is there a process/form for changing the student's name/gender marker in the SIS?

YesNo

If so, how will it be accessed/used?

Name entered into the Student Health Record

If needed, is there a process/form for changing the student's name/gender marker in the Health Record?

YesNo

If so, how will it be accessed/used?

If not, how will the student's confidentiality be protected?

Who will be the point person at school for ensuring that these adjustments to the student's records are made and communicated as needed?

If the student's name/gender marker cannot be modified in the above systems, how will the student's privacy be accounted for and/or maintained in the following situations or contexts:

Reporting student data to the state/other entities

During registration

Completing enrollment

Student cumulative file

IEPs/Other services

Seating charts/Taking attendance

With substitute teachers

Teacher grade books

Standardized tests

School photos

Student ID/Library card

Lunch lines/Free Lunch Card

Yearbook

Assignment of IT accounts/email address

Distribution of texts or other school supplies

After-school program

Official school-home communications

Unofficial school-home communications (PTA, etc)

Outside district personnel or providers

Summons to the office

PA Announcements

Posted lists

How will instances be handled when the incorrect name or pronoun are used by staff members?

How will instances be handled when the incorrect name or pronoun are used by students?

If the student's guardians are not aware of/supportive of the student's gender status, how will school-home communications be handled, including when individual staff members need to contact guardians?

What are some of the ways the school needs to anticipate the student's privacy being compromised - how will these be handled?

Page 3

Use of Facilities

Student will use the following bathroom(s) on campus

Student will change clothes in the following place(s)

If the student and/or parent has questions/concerns about the use of facilities, who should they contact?

What are the expectations regarding the use of facilities for class trips?

What are the expectations regarding rooming for any overnight trips?

Are there any other questions or concerns about the student's access to facilities?

Extra-Curricular Activities

In what extra-curricular programs or activities will the student be participating (sports, theater, clubs, etc)?

What steps will be necessary for supporting the student in extra-curricular activities?

Does the student participate in an after-school program?

YesNo

If yes, what steps will be necessary for supporting the student in after-school?

Are there any other questions or concerns about extra-curricular activities?

Other Considerations

Does the student have siblings at school?

YesNo

Factors to consider regarding siblings' needs

Does the school have a dress code?

YesNo

If yes, how will this be handled?

Are there lessons, units, content or other activities coming up this year to consider (growth and development, swim unit, social justice units, name projects, dance instruction/school dances, Pride unit, etc)

Are there any specific social dynamics with other students, families, or staff members that need to be discussed or accounted for?

Does the student use school- or district-provided transportation services?

YesNo

If yes, how will the student's gender be accounted for?

What training(s) will the school engage in to build capacity for working with gender-expansive students - how will the school work to create gender inclusive conditions for all students?

Are there any other questions, issues or concerns to discuss?

Page 4

Action Steps

List the specific follow-up and/or action items emerging from this meeting, with who is responsible and a deadline/timeline:

Item

Who is responsible

Deadline/timeline

Next Steps: Gender Support Plan Review and Revision

How will this plan be monitored over time?

What will the process be should the student, family or school wish to revisit any aspects of the plan (or seek additions to the plan)?

Next Meeting

Date and time of next meeting or check-in

Location

Click "Review" to edit, download and/or print your completed plan. YOU DO NOT NEED TO "CONFIRM" YOUR PLAN AS PROMPTED; YOU CAN IGNORE THE MESSAGE YOU WILL RECEIVE WHEN YOU CLICK "REVIEW." IF YOU DO CLICK "CONFIRM," USE YOUR BROWSERS BACK BUTTON TO GO BACK TO YOUR COMPLETED PLAN.