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