Qualtrics Survey | Qualtrics Experience Management

Student's Name

GTID#

Student's Email Address

Current Major

Please select the major(s) that the student is interested in exploring?

I am not sure which major (s) the student is interested in.
Aerospace Engineering
Applied Language and Intercultural Studies
Applied Physics
Architecture
Biochemistry
Biology
Biomedical Engineering
Business Administration
Chemical & Biomolecular Engineering
Chemistry
Civil Engineering
Computational Media
Computer Engineering
Computer Science
Earth and Atmospheric Sciences
Economics and International Affairs
Economics
Electrical Engineering
Environmental Engineering
Global Economics and Modern Languages
History, Technology & Society
Industrial Design
Industrial Engineering
International Affairs and Modern Languages
International Affairs
Literature, Media, and Communications
Materials Science and Engineering
Mathematics
Mechanical Engineering
Music Technology
Neuroscience
Nuclear and Radiological Engineering
Physics
Psychology
Public Policy

Is the student referring themselves or being referred by an advisor?

No, I am a student referring myself.
I am an advisor referring my student.

Has the student been informed that they have been referred to the Exploratory Advisor?

Yes
No

Reason for Referral

Student is interested in exploring additional majors, minors, or certificates.
Student has a major and no longer feels like it is the right fit.
Student is completely undecided.
Student has a career in mind, but is unsure of their major.
Student is not making academic progress in their current major.

Name and Department [Referral Submitter]

Advisor's Email Address

Would you like a follow-up email, after the student attends an appointment?

Yes
No

Would you like to learn more about free tutoring resources at Georgia Tech? Please select "Yes" if you would like to schedule a meeting with someone from The Office of Tutoring and Academic Support.

Yes
No