Title IX Incident Report
This form is designed to report a violation of Title IX. We appreciate any contact information you are willing to provide. You are welcome to remain anonymous if desired. If you have any documentation of the incident (e-mails, letters, pictures etc), please turn those in to our Title IX coordinator, Jeremy Dorman, Martha Miller Administration Building – Office of Human Resources. 903-693-2021 or firstname.lastname@example.org
By completing this form, you acknowledge that you are initiating a complaint which will be investigated per Panola College policy. You certify that the following information is accurate to the best of your knowledge. Please contact the local authorities if you need immediate assistance by dialing 911 or calling Campus Police at 903-693-1111.