Incident Report
Please fill this form out to the best of your ability. Sagamore takes any incident involving a teacher seriously and needs the most accurate and complete information to take any necessary steps to address the incident. We are required to report certain types of incidents to the US State Department. This form is very important to help us document your concerns. Thank you!
Today's Date
Teacher First and Last Name
Teacher passport number
Date Incident Occurred
What was the nature of the incident? Check all that apply.
Incident involving Criminal Justice System
Employment and Contract Issues
Unsuitable Working Conditions
Serious Mental Health Concerns
Substance Abuse
Serious Illness or Injury
Sexually-Related Abuse
Foreign Government or Embassy Intervention
Situation that impacts Teacher Safety
Lost or Stolen documents
Sponsor Violations
Other
Please write a brief description of the incident.
To whom has this incident been reported (your principal or school hr office, police, etc.)?
What steps have you or others taken to resolve the incident?
Does this incident require a trip to your home country (for example an illness or death in the family)?
Yes
No
Not right away, but maybe later
If you answered YES to the question above, be sure that your DS2019 has a current travel validation signature (signatures are valid for one year). If you need to update the signature, please let us know the form
linked here
.
Contact Information