Michigan State University
Office of Study Abroad Incident Report for Crime Abroad

Date of Report: __________ Reported to (OSA Staff): _______________

Date of Incident: ___________ Reported by (on-site): _______________

Program Name: _______________________________________________

Location of Incident: _____________________________________________

Victim: ___ Male ___ Female ___ Student ___Faculty

Was Alcohol Involved: ___ Yes ___ No

Description of Incident: ___________________________________________

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Was a police report filed? ___ Yes ___ No Copy available? ___ Yes ___ No

Follow-up: _______________________________________________________________

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