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This form may be completed by any member of the Jenks Public Schools (JPS) community who has experienced an incident that may constitute a violation of the JPS Policy 1.55 Title IX.
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JPS Policy 1.55 Title IX tawh ki tuak lo, alang pang tawh aki bang thupiang atuak kha Jenks Public Schools (JPS) community sung a om member khat peuh peuh in hih form zang thei hi.
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Please complete the form to the best of your ability.
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Hehpih na tawh hih form tung ah ahoih pen in na hih theih zah in at in.
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Bring or send this form to the Title IX Coordinator or Deputy Coordinators as listed on the website.
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Website tung aki gelh ahi Title IX Coordinator ahih kei leh Deputy Coordinators kiang hih form ap in ahih kei leh khak in.
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Today's Date
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Tuni
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Complainant Name
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Thu puak nu/pa Min
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JPS Student or Employee ID
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JPS Sang naupang ahkl. Employee ID
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Phone Number
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Phone Nambat
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School / Work Location
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Sang/Nasep na Mun
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Your JPS Affiliation
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JPS tawh na ki nai na
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Student
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Sang naupang
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Employee
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Nasem
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Parent/Guardian
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Nulehpa/Akem
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No Affiliation
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ki nai na nei lo
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Incident Date
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Thu pian ni
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Incident Time
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Thu pian hun
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Incident Location
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Thu pian na Mun
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Type of Incident
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Thupiang Nam
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School Building / Office
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Sang inn/zum
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Outdoors on school grounds
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Sang huang sung apua ah (Outdoor)
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JPS transportation
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JPS sang mawtaw
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JPS sponsored event
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JPS te sponsor na pawi te
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Protected Class(es) Basis for Report
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Aki pulak lo ding nam(te) Thu puak na ah aki sam
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Discrimination
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Ki deidan na
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Harassment
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Ki nawngkai sak na
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Violence / Sexual Assault
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Ki simmawh bawlna/Numei leh pasal lam ki zawh thawh na
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Stalking
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Ki zuihzuih na
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Retaliation
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Ki thuk kik na
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Race
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Minam
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National Origin
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Gam mi masa hih na
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Color
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Color
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Age
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Kum
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Religion
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Biakna
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Disability
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Dam loh na
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Sex (including pregnancy, sexual orientation, or gender identity)
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Sex (naupai, numei/pasal lung gulh na ahkl. numei/pasal hih na,te ki hel hi)
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Other Specific Location
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Apian na mun Lian
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Respondent
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Respondent (Athuk)
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Respondent's JPS Affiliation
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Respondent nu/pa leh JPS ki nai na
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Contact Information (if known)
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Ki zop na ding (na theih aleh)
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Name of Witness 1
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Hong theih/muh pih mi 1 na ih min
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Incident Narrative (This can be brief. A full statement will be taken by the investigator.)
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Apiang thu gen na (Atom in ki at thei hi. Aki cing in a sit te in kan ding uh hi)
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Signature
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Letmat
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Date
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A ni
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Signature optional unless a complaint is initiated by the Title IX Coordinator. Parent/guardian may sign on behalf of their child.
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Title IX Coordinator pat khiat thupuak na ahih kei leh na ut leh letmat ki thuh thei hi. Naupang te tang in a nulehpa/akem te in thuh thei hi.
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Received By
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Kei mah ... in ka ngah hi
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Supportive Measures Requested
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Aki Ngen Panpih na Piak na te
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No Contact Order
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Ki zom sak lo (No Contact Order)
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Teacher Notification
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Sia/mah te theihsak na
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Safety Plan
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Bitna om nang gelna
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Counseling
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Thu ki kuppih na
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School Escort
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Sang ah a cing koih na
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Workplace Adjustment
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Nasep na tawm ki khel sak na
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Medical Care
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Cidam na lam khoi na
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Academic Adjustment
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Pilna sinna tawm ki khel na om sak na
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Assistance Reporting to Law Enforcement
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Law Enforcement tung ah huhna pulak na
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Legal Support Information
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Legal apan pih na thu
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Victim Advocate Outreach
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Thukhen zum ah genna
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Accommodations
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Om na khawl na gel sak na
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I request an interpreter. Language:
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Kamphen ka ngen hi. Kampau:
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I request accommodation(s) for a qualified disability
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Aki ciamteh damlo khat ka hih na tawh om na khawl na gel sak ding ka ki sam hi
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Action Requested
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Aki Ngen Sepsak ding
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Informal Resolution
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Limtak aki kum ding
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Formal Investigation
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Hoih tak in thukan ding
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Meet with Title IX Coordinator
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Title IX Coordinator tawh ki mu ding
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Transition: a positive start to school
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Kikheelna: a hoih lama saangkah kipatna
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Guidelines to help families complete the Transition Learning and Development Statement
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Siamsinna leh Khantohna Kikheelna Pulaakna tungtang innkuan te in hoih taka malak theihna ding kimakaihna
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Why is a positive start to school important?
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Bang hangin a hoih lama saang kipat ding kisam ahi hiam?
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A positive start to school leads to better learning and wellbeing outcomes
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A hoih lama saang kipatna in na taa pen kipattung sinna pana saanginnpi kahtohna lamah panpih in lungmuangsak hi
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Transition helps your child feel secure and confident
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A hoih lama kikheelna in na taa siamsinna leh khantohna lamah panpih in a theihsa thu te leh a sin lai ding te ah lungmuangsak in
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A positive start to school helps them settle in
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A hoih lama saang kipatna in zong amaute sek in dau sak hi
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What is the Transition Learning and Development Statement?
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Siamsinna leh Khantohna Kikheelna Pulaakna bang ahi hiam?
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Services and families work together for the child
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Naupang kemcing nasepna saanginn Saanginn Pua lam Kikepna (OSHC) malakna leh innkuan te pangkhawm uh hi
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Information is shared through the Transition Learning and Development Statement (TLDS)
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Siamsinna leh Khantohna Kikheelna Pulaakna (TLDS) tungtawn in thu le laa kihawm tuah uh hi
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The early childhood service writes the TLDS for each child
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Hih pen naupang kemcing nasepna in naupang ciat in saang a kahna uh ah gelh uh hi
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TLDS informs the school about your child's learning and health
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TLDS in na taa siam sinna lam khantohna leh cidamna tungtang te naupang kemcing nasepna leh saanginn ah theisak uh hi
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It summarizes interests skills and teaching strategies
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TLDS in tom kim kician takin na taa lunggulh lamte khutsiamnate leh mimal kikep dan ding zia leh kimakaih dan ding a bawl hi
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TLDS helps the school get to know your child
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Saangkah a kipat a kipan na taa na telsiam theihna ding leh a siam sinna lam na panpih theihna dingin TLDS in hong huh thei hi
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Foundation teachers use the information to understand the child
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TLDS pana thu kiza te tungtawn in Bulpatna lam saangsia te in na taa telsiam in a sim ding kisam te thei thei ding uh hi
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TLDS can also be shared with Outside School Hours Care (OSHC)
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Na taa pen OSHC lamah ah a kihel ding leh TLDS in a hunzat dan ding hong vaihawm sak thei lai ding hi
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TLDS contains name date of birth and contact details
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TLDS te in na taa tungtaang a min a suah ni le kum a maan leh nangma min leh hong kihopih theihna ding kem uh hi
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It may contain contact details for other professionals
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Tua banah naupang kepcing nasepna lama na taa a kem sia adangte min leh hopih theihna zong kem kha ding uh hi
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Participating in transition helps you and your child
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TLDS lama na taa panpihna pen saang kipat ma in saanginn vai ading kikheelna ah nang leh na taa na pankhawm theihna thei uh ahi hi
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How will my child's TLDS be created?
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Bangci ka taa TLDS sazian hong hi thei ding hiam?
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Services will provide a link to the online TLDS
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Naupang kemcing nasepna te in online tungtawn a TLDS muh theihna ding link hong pia ding uh hi
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Online is the best way to complete the TLDS
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Online tungtawn a TLDS pen TLDS a kisam gelh theihna dinga hoih pen ahi hi
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If you cannot access online you can request a paper copy
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Online tungtawn a na ngah theih kei leh a laidal khat na ngen thei ding hi
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Where do I need to write in the TLDS?
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TLDS sung koi tengah gelh kisam ka hi hiam?
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Section 1 is completed by the early childhood service
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Khen 1 leh 1.1 pen na taa naupang kemcing nasepna makai te in gelh ding uh hi
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Section 1.2 is for children with developmental delays
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Khen 1.2 pen na taa in poina ahi zong khantohna lam zeikai ahih khak leh na taa naupang kemcing nasepna makai te in gelh kha thei ding uh hi
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Other professionals may also contribute
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Na taa a panpih midang misiam te in zong gelh kha thei ding uh hi
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Section 2: The Child is for the child to fill in with help
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Khen 2: Naupang pen na taa leh picing a theihcian uh tawh gelh ding hi
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This can be a parent or the teacher
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Hih pen nang ahih kei leh naupang kemcing nasepna makai hi ding hi
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Section 3: The Family is for you to complete
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Khen 3: Innkuan pen nangma gelh ding ahi hi
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Include your child's interests and expectations for school
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Hih khen ah dotna om a na taa lunggulh lam theihsak na ding tua banah na ngaihsutna leh na taa ading saanginn a lametna na neih te na gelh ding hi
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This helps teachers plan for your child's learning
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Hih dotna te dawnna in saangsia te leh OSHC nasemte in na taa a telsiam theihna ding leh malakna a bawl theihna dingin siamsinna leh khantohna lamah panpih thei ding hi
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What happens after the TLDS is finished?
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TLDS man khit ciang bang piang ding?
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Educators will provide a full printed copy for you
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TLDS na man khit ciangin naupang kemcing nasem te in a vekpi in a khetkhiat sa in hong pia ding uh hi
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Services will send the TLDS to the school and OSHC
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Naupang kemcing nasem te in a saanginn leh OSHC (a kisap leh) ah TLDS na khak ding uh hi
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If you haven't chosen a school the service will give you a copy
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Na taa koi saanginn ah kah ding na theihciat kei leh naupang kemcing nasemte tung panin TLDS khetkhiat sa hong pia kik ding uh hi
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Provide this when you enroll your child
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Saanginn ah na taa min na khum ciangin na pia kawm ding hi
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If you do not want information shared discuss it with the educator
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TLDS pen na taa sanginn ah theihsak ding lam na sak kei leh hehpihna toh naupang a kemcingte na kiho pihpih in
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