GT Student Group Trip Incident Report

Utilize this form to submit an incident report for international Georgia Tech student groups. This form will be received by the Office of International Education and information will be shared with any relevant campus partners (i.e. Office of Student Integrity). This form is for documentation purposes; in the event of an emergency, contact local emergency services as needed and the Georgia Tech Police Department at (404) 894-2500 to be connected to the Dean on Duty.

Program Name

First and Last Name of Person Submitting Form

Role of Person Submitting Form

Faculty/Staff

Student

Parent

Other…

Overseas Contact Number of Person Submitting Form

Date and Time of Incident

Location of Incident

Involved Parties

Include: First and Last Name(s), GT ID(s), GT Email(s), and Role (accused, witness, or staff)

Incident Description

Describe the incident in as much detail as possible.

Emergency Contacts

Yes

Have any emergency contacts been notified, for any of the parties involved?

Emergency Contact Details

If so, who?

Police Report Number (if applicable)

Supporting Documentation Upload (if applicable)

One file only.
500 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

What assistance, if any, is needed from Georgia Tech at this time?

Georgia Institute of Technology