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Intake Form: Supporting Student Gender Identity

About this Form

Form number: 560-80

Audience:  MCPS Staff

Last revised: October 2022

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. 


Adobe PDF Intake Form: Supporting Student Gender Identity78 KEnglish
Adobe PDF Formulario de Toma de Datos: Apoyo a la Identidad de Género de los Estudiantes443 KSpanish
Adobe PDF Formulaire d'admission : Soutien à l'identité de genre des élèves442 KFrench
Adobe PDF Mẫu Thâu Nhậ n: Hỗ Trợ Nhận Dạng Giới Tính của Họ c Sinh511 KVietnamese
Adobe PDF 登記表: 支持學生的性別認定562 KChinese
Adobe PDF 접수 양식: 학생의 성 정체성 지원(Supporting Student Gender Identity)472 KKorean
Adobe PDF የተማሪ የጾታ መለያ ድጋፍ መቀበያ ቅጽ፦462 KAmharic

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