Burrell College of Osteopathic Medicine
Title IX: Sex Discrimination and Harassment Policy
Formal Complaint Form

This form may be completed by any member of the Burrell community who has experienced or otherwise become aware of an incident that may constitute a violation of the Title IX: Sex Discrimination and Harassment Policy. Please complete the form to the best of your ability.

If there is a potential conflict with the Title IX Coordinator, please contact Executive Director of Human Resources, Dawn Leake, 575-674-2284, dlkeake@burrell.edu, Office 351.

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  • A copy of this completed form will be sent to your email.
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