SAFETI Clearinghouse : 161 Course Syllabus

Student, please circle Semester Abroad: Fall/Spring/Summer

UNIVERSITY OF THE PACIFIC
INTERNATIONAL PROGRAMS AND SERVICES
SAFETY INCIDENT SURVEY

The following questions refer to a number of different incidents students are sometimes victims of while abroad. We are interested in any incidents that may have occurred while you were overseas.

1. Your age while abroad: ______

2. What was your class standing while you were abroad?
Fr Soph Jr Sr Grad

3. Gender:
M F

4. Where did you study abroad?
City and country: __________________________ How long? _____
City and country: __________________________ How long? _____

5. What study abroad program where you in?

_____________________________________________________
University & Program sponsor (IES, USAC, etc.)

_____________________________________________________
University & Program sponsor (IES, USAC, etc.)

6. Did you know how to use a telephone in an emergency?
Yes No

7. Did you know the location of police or appropriate authorities for reporting an incident?
Yes No

8. Were you aware of the unsafe districts in the area where you lived?
Yes No

9. Was illegal or disturbing drug-related activity evident on the campus or area where you lived?
Yes No

10. Did anyone intentionally damage your property (e.g., car, bike, room)
Yes No

11. Did anyone steal anything from you? (Example: from your room, car or luggage, even if it was something minor. Include Theft of books.)
Yes No

12. Did anyone take anything from you using force or the threat of force?
Yes No

13. Did anyone attack you intending to do harm?
Yes No

14. Did you experience any obscene or annoying behavior, not involving violence?
Yes No

15. Did you witness any indecent exposure?
Yes No

16. Did a sexual crime or assault happen to you?
Yes No

17. Did you experience any other form of danger not directed specifically at you?
Yes No

If yes, please explain: _____________________________________

______________________________________________________

______________________________________________________

______________________________________________________

______________________________________________________

18. Did you have first-hand knowledge of any kind of crime occurring to someone on your program or in your area?
Yes No

19. In general, how safe did you feel when traveling overseas?

Very safe Very Unsafe

1 2 3 4 5

20. In general, how safe did you feel at your host campus?

Very safe Very Unsafe

1 2 3 4 5

21. Do you think you were adequately prepared and/or warned to deal with most incidents mentioned in this survey before your departure from your home country, or upon immediate arrival in your host country?
Yes No

22. If above question #21 answered as “No,” how do you feel you may have been better informed and prepared?
______________________________________________________

______________________________________________________

______________________________________________________

______________________________________________________

Revised April 2003