Fill out the relevant sections of this form and then click the 'Submit Form' button at the bottom of the page to submit your report. Use the 'Reset Form' button at the bottom of the page to clear all entries and start over. Remember to fill out one form per incident. If requested, a staff member from the Center for Global Education will follow up within one business day.

In case of immediate need or emergency, please connect with your on-site staff & call SJU Security at 320-363-2144. Your call will be relayed to one of our staff members.

General Incident Information

Person Reporting Incident

CSB+SJU email

Date of incident

Time of incident (local)

City and Country where incident occured

Semester Study Abroad Program

-OR-

Short-Term Study Abroad Program

OTHER Short-term Study Abroad Program (if applicable)

Location Details (i.e. student apartments/classroom/city):

Activity at Time of Incident

Incident Narrative (REQUIRED):

Did this incident involve an injury or illness that required admission to a hospital (excluding outpatient care admissions)?

	YES
	NO

CSB/SJU students involved:

Non-CSB/SJU persons involved:

Who has been notified? Check all that apply.

	Host Institution or Partner
	Police
	Medical Professional
	Parent/Guardian

I would like a staff member from the Center for Global Education to follow up with me regarding this incident:

	NO
	YES

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Study Abroad Incident Report

General Incident Information