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AC-E-6, Student Identity Change Request Form

AC-E-6, Student Identity Change Request Form

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This form must be submitted by a parent/guardian to change a student’s first and/or middle name, gender, and/or pronouns within the Thompson School District Student Information System, when there is no documentation of a legal change to name or gender. Completion of this form updates the student’s identity to their preferred or “assumed” identity within the district’s student information system.

By submitting this form and signing below, parent(s)/guardian(s) understand that:

  1. This form does not constitute a legal name and/or gender change; rather it only changes the name and/or gender of the student as reflected in the TSD Student Information System from the date of request and moving forward.
  2. A record of the student’s legal name and/or legal gender will be maintained in the TSD Student Information System to enable records to be cross-referenced while maintaining confidentiality.
  3. In some instances, the State of Colorado may require the District to use the student’s legal name and/or legal gender for state reporting and accountability purposes.
  4. This form will be maintained in the student’s cumulative file, which is protected from disclosure to third parties in accordance with the Family Educational Rights and Privacy Act (FERPA). Changes to records in the student’s cumulative file may be requested in accordance with FERPA (see District Policy with appropriate legal documentation).

HAVING CONSIDERED THE FOREGOING INFORMATION, I HEREBY REQUEST THAT:

Student’s Legal Full Name/Gender:

  • First Name, Middle Name, Last Name
  • Suffix
  • Gender

BE CHANGED IN THE TSD STUDENT INFORMATION SYSTEM TO*:

Student’s Assumed Name/Gender/Pronoun:

  • First Name, Middle Name
  • Suffix
  • M / F / NonBinary
  • He / She / They

I, as the Parent/Guardian, permit TSD to release this Assumed Identity information about the above-listed student, if said student transfers out of the Thompson School District and their new educational system requests their educational records. By NOT checking the box, assumed identity information will remain with TSD, and ONLY LEGAL information will be shared with any requesting institutes of education.

  • Parent/Guardian Printed Name
  • Parent/Guardian Signature
  • Date

*If you are requesting the use of an assumed first and/or middle name in our TSD Student Information System, we advise you to also proceed with a legal name change. Information for requesting a legal name change may be found by visiting the Colorado Judicial Branch website and searching for “name change”

Revised August 21, 2024