Boulder Valley School District

AC-E4

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  • Foundations and Basic Commitments

File: AC-E4 (pdf)
May 10, 2016


CONFIDENTIAL
GENDER TRANSITION PLAN

The document supports the necessary planning for a student’s formal transition of gender from its commonly assumed status to something else. Its purpose is to create the most favorable conditions for a successful experience, and to identify the specific actions that will be taken by the student, school, family, or other support providers.

School: ________________________________________

Today’s Date:____________________

Student’s Preferred Name: ___________________________________________

Legal Name: ______________________________________________________

Student’s Gender: ___________________

Assigned Sex at Birth: ________________

Student Grade Level: _________________

Date of Birth:________________________

Sibling(s)/Grade(s):
___________________________________(_____)/
___________________________________(_____)/
___________________________________(_____)/
___________________________________(_____)/
___________________________________(_____)

Parent(s)/Guardian(s)/Relation to Student:
_________________________(_________________________)/
_________________________(_________________________)/
_________________________(_________________________)/
_________________________(_________________________)

What is the nature of the student’s transition (male-to-female, female-to-male, a shift in gender expression, etc.) ___________________________________________________________________________

PARENT GUARDIAN INVOLVEMENT

Are guardian(s) of this student supportive of their child’s gender status? ____Yes ____No
If not, what considerations must be accounted for in implementing this plan? ___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

 

INITIAL PLANNING MEETING

When will the initial planning meeting take place? _____________________________________________________________________________

Where will it occur? _____________________________________________________________________________

Who will be the member of the team supporting the student’s transition?

  • Student_________________________________________________________________
  • Parent(s)_______________________________________________________________
  • School Staff ____________________________________________________________
  • Other___________________________________________________________________

STUDENT TRANSITION DETAILS

What specific information that will be conveyed to other students (be specific)? ____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

What requests will be made? ____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________


With whom and when will this information be shared?

  • With peers in the transitioning student’s class only
    Date:____________________________________
  • With peers in the student’s grade level     
    Date: ____________________________________
  • With some/all students at school (specify)_______________________________
    Date: ____________________________________
  • Other (specify)_____________________________________________________ 
    Date: ____________________________________

Who will lead the lessons/activities framing the student’s announcement? _____________________________________________________________________________
_____________________________________________________________________________

What will the lesson/activities be? _____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

Will the student be present for the lesson/sharing of info about the transition? _____Y _____N
If yes, what if any role does the student want to play in the process? _____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

Once the information is shared, what parameters/expectations will be set regarding approaching the student? _____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

Other notes, considerations, or questions: _____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

KEY DECISIONS PRIOR TO STUDENT’S TRANSITION
Communications with Other Families

Will any sort of information be shared with other families about the student's transition? ______________________________________________________________________________
______________________________________________________________________________

With whom: _____Families in child's grade _____Whole School _____Other (specify) ______________________________________________________________________________

Who will be responsible for creating this? ______________________________________________________________________________

When will it be sent? ______________________________________________________________________________

How will it be distributed? ______________________________________________________________________________

What specific information will be shared*? ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Questions/Notes: ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

* see sample letters

Training for School Staff

Will there be specific training about this student's transition with school staff?
_____Y _____N  When? _______________________________________________


Who will be conducting the training? What will be the content of the training? ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Questions/Notes: ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Parent Information Night about Gender Diversity

Will there be specific training for school community member? _____Y _____N  
When? ________________________________________________________________________

Who will conduct it? Will it reference the student's transition? What will be the content of the training? ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Questions/Notes: ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Class Meeting with Parents

Will there be any meeting with the families of the transitioning student's peers? When? ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Who will lead the meeting? Who will be attending the meeting? ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

What will be the purpose for this meeting? ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Identifying and Enlisting Parent Allies

Are there any parents/adults in the community you would like to enlist in support of the child's-transition? If so, who? ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

When will you speak with them? What will be your request? ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Questions/Notes: ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Identifying and Enlisting Peer Allies

Are there other students you would like to enlist in support of the child's transition? If so, who? ______________________________________________________________________________
______________________________________________________________________________

When will they be spoken with? What requests will be made? ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Questions/Notes: ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Siblings

Does the student have any siblings at the school?  What needs to be considered for them? ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Training in their classroom (s)? ______________________________________________________________________________
______________________________________________________________________________

Emotional Support? ______________________________________________________________________________
______________________________________________________________________________

Questions/Notes:________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

TIMELINE

Which of the following will take place in relation to this student's gender transition, and when will it occur and who will be responsible for making it happen?

 ✔   Activity Date Lead
  Initial planning meeting                                    
  Lessons / activities with other students    
  Communications with other families    
  Training for school staff    
  Parent information night about gender diversity    
  Class meeting with parents    
  Identifying and enlisting parent allies    
  Identifying and enlisting peer allies    


What are the specific follow-ups or action items emerging from this meeting and who is responsible for them?

Action Item Who? When?
     
     
     
     
     
     
     
     

 

Date / Time of next meeting or check in
______________________________________________________________________________

Location
______________________________________________________________________________

 

Exhibit:
End of File: