Student Incident Report

Date

Class Title

First Name (if you wish to share it)

Last Name (if you wish to share it)

Email (Required if you would like the Hugo House staff to follow up with you)

What happened? Please include which part(s) of the Student Guidelines were violated.

Did anyone address the situation in class and/or privately with the student(s) or teacher in question?

Do you have requests of the teacher, another student, or Hugo House? Are there reparations that should happen?

Would it be safe, in your opinion, for the harming teacher/student(s) to continue in your class and/or lead/participate in another class at Hugo House? Are there actions that the teacher/student can take to participate safely in the future?

What would you recommend happens next?

If you are human, leave this field blank.

Student Incident Report

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