Individuals designated as Officials with Authority (OWA) or Mandatory Reporters by Burrell College must complete this form upon receiving notice of an alleged violation of Title IX: Sex Discrimination and Harassment Policy and submit it to the Burrell Office of Compliance upon completion. Questions regarding this form should be directed to Nina Nunez, MAED, nnunez@burrell.edu, 575-674-2339

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.

  • MANDATORY REPORTER INFORMATION

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

  • REPORT INFORMATION

  • MM slash DD slash YYYY

  • INCIDENT INFORMATION

  • MM slash DD slash YYYY

  • INCIDENT DESCRIPTION

  • RESPONSE