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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 |
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