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Transgender Students Report Form

Transgender Student Report Form is to be used to report any transgender student who may be having difficulty in school. This form is confidential and will only be shared with school staff who need to know about the student's transgender status.

Time to complete

3 minutes

Eligibility

Students who identify as transgender are eligible to fill out the Transgender Students Report Form.

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Questions for Transgender Students Report Form

1.

Full Name

The answer should be a text input.
2.

Age

The answer should be a single choice:
  1. Under 18
  2. 18-24 years old
  3. 25-34 years old
  4. 35-44 years old
  5. 45-54 years old
  6. Over 55
3.

Date of Birth

The answer should be a date input.
4.

Home Address

The answer should be a text input.
5.

Email Address

The answer should be an email input.
6.

Nationality

The answer should be a country.
7.

Gender

The answer should be a single choice:
  1. Male
  2. Female
  3. Transgender male to female
  4. Transgender female to male
  5. Non Binary
8.

Father's Name

The answer should be a text input.
9.

Mother's Name

The answer should be a text input.
10.

What are your parents'/guardians' occupations?

The answer should be a text input.
11.

What is your school's name?

The answer should be a text input.
12.

What grade are you in?

The answer should be a text input.
13.

How do you feel about being transgender?

The answer should be a text input.
14.

Have you experienced any discrimination or violence because of your gender identity? If so, please describe what happened.

The answer should be a text input.
15.

Are there any transgender-related medical procedures that you have undergone or are considering undergoing?

The answer should be a text input.
16.

Do you feel your transgender identity is accepted by your friends?

The answer should be a single choice:
  1. Yes
  2. No

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Here are some FAQs and additional information
on Transgender Students Report Form

How do I know if I am a transgender student?

There is no one answer to this question. Each person's experience is unique. However, if you feel that your gender identity does not match the sex assigned to you at birth, or if you feel that you are not comfortable with the gender role typically associated with your sex, you may be transgender.

What is the purpose of the Transgender Students Report Form?

The Transgender Students Report Form is intended to help track and improve the campus climate for transgender students. The information collected will be used to identify and address areas of concern, and to develop and implement programs and services that are responsive to the needs of transgender students.

Who is required to complete the Transgender Students Report Form?

A: All students who identify as transgender, gender non-conforming, or genderqueer are encouraged to complete the form. The form is also open to students who do not identify as transgender, but who have experienced harassment or discrimination on the basis of their gender identity or expression.

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