VOLUNTARY STATEMENT
This form may be used by any residential student who wishes to submit a statement to the Department of Residential
Life. This form may be submitted independent of or in addendum to a staff Incident Report. Your statement may be
forwarded to New Mexico Tech Campus Police or The Dean of Students office. This form does not substitute for or
supersede any other report which is filed or which may be filled with any other office at New Mexico Tech, including
Campus Police. Residents are encouraged and expected* to report criminal activity directly to a Campus Police
Officer and can be accompanied by Residential Life Staff if they wish.
*Please note, victims of sexual misconduct are not required to report
incidents to Campus Police. It is completely the decision of the alleged victim whether they wish to speak with law enforcement and victims have the right to report an
incident to police without being compelled to pursue criminal charges. If you have been involved in any incident involving sexual assault, misconduct or harassment,
Campus Police or Residential Life staff can provide you with important information regarding after care and your rights and options. Please note that in accordance with
federal Clery Act mandates, campus security personnel (Residential Life staff included) are required to make a date, time and location report whenever they are
informed about a sexual assault. However, neither the name nor other identifying information will be disclosed without the victim’s consent.
Report date: Report time:
Name of reporting person:
Phone number you can be reached at:
College Residence & Room:
Off Campus Address:
Incident Date: Incident time:
Incident Location:
Describe anything you wish to state in detail (attach additional voluntary statement forms if necessary). When applicable, please
specify the names and involvement of other people involved along with any identifiable information you may have for them such
as whether they are students/ non-students, their campus/off campus addresses, etc.
Voluntary Statement:
Reporter signature:
Date:
Page of Pages
My signature above signifies that I have written and reviewed this
statement and the information herein is true and correct to the best of my
knowledge. I understand this form may be used in Tech student conduct
proceedings and shared with other college officials in whole or in part.
Staff member
receiving this report:
Date:
NMT Residential Life 801 Leroy Place Socorro New Mexico 87801 575.835.5900 Fax: 575.835.5907 residential_life@admin.nmt.edu
