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Incident Report Form

IF THIS IS AN EMERGENCY, PLEASE CONTACT 911!

Please provide as much information as possible. Complete reports make it more likely that the proper campus office will be able to assist in a timely manner.

For further information, please refer to our website.

Background Information

Please note that a students' conduct records are a part of their educational records and they have a right to obtain a copy of this report if requested. Therefore this report is not confidential.

While anonymous reports are accepted, you are STRONGLY encouraged to provide your name and contact information in order to allow us to most effectively address the concerning behavior.

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Your full name:

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Or, you may write Anonymous

Your position/title:

Your phone number:

Your e-mail address:

Email address must be of a valid format.

Your physical address:

Date of incident(Required):

This field is required.

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Must be formatted YYYY-MM-DD

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

This section is for students only. Please do not list any professional staff or faculty in this section.

Name

Select Gender

Select Role

HSU ID Number

Date of Birth (YYYY-MM-DD)

Phone Number

E-mail Address

Hall/Address

Questions

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Background Information

Involved Parties

Questions

Supporting Documentation

Submission