Clone of Student Intake Form 1

This is where your report starts. The questions below help us understand your academic background and career interests better. Be specific — vague answers produce vague results. The quality of your assessment depends directly on the quality of your answers. Don't rush it. There are no right or wrong answers — only honest ones.

Full Name

First NameLast Name

Email - This is where your assessment and reports will be delivered.

Which college you're in?

What is your current year in college?

What's your declared major(s) and minor(s)?

What is your current GPA? (optional -- self-reported, used only to flag feasibility)

Which best describes you?

What specializations are you already considering? Rate each specialization 1-5 on "how strongly you are identified with this specialization".

Rows	Specialization	Rate (1-5)
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3

What's forcing the decision now?

Ranking

Geographic flexibility

List the courses you've taken so far relevant to your major or future career. Rate each course 1-5 on "wanted to keep learning this".

Rows	Course Name	Rating (1-5)
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3
4
5
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7
8

Describe one class, project, or job where you lost track of time. "N/A" if none

0/300

Check what you want your work to involve, day to day (Check all that apply)

Which of these would you refuse even if it paid well?

List any jobs or internships you've had. "N/A" if none.

Rows	Role/Title	Organization	One-line description on what you did
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Additional

List any research/publication/project you had. N/A if none.

Rows	Type	Title/Topic/One-line description on what you did
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Additional

What skills or tools have you developed. "N/A" if none.

Rows	Please specify
Coding/programming
Design (graphic/UX/etc)
Data analysis
Foreign language(s)
Writing/content
Public speaking/leadership
Other

*Your signature below indicates that the information you have provided above is truthful.

Date

Signature

Reports will be delivered within 72 calendar hours. Orders received after 5:00 PM ET on Friday or during weekends will begin processing the following Monday at 9:00 AM ET. The 72-hour delivery window for such orders begins at Monday 9:00 AM ET, regardless of when the order was originally submitted.

My Products

Roadmap Bundle

$449.00

Total

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

UTM Source

UTM Medium

UTM Campaign

STUDENT INTAKE FORM

SECTION 1: BASELINE

SECTION 2: SITUATION TYPE

SECTION 3: YOUR VALUES

SECTION 4: EXPOSURE SIGNAL

SECTION 5: YOUR CAREER

SECTION 6: YOUR BACKGROUND & PREPARATION

My Products

STUDENT INTAKE FORM

SECTION 1: BASELINE

SECTION 2: SITUATION TYPE

SECTION 3: YOUR VALUES

SECTION 4: EXPOSURE SIGNAL

SECTION 5: YOUR CAREER

SECTION 6: YOUR BACKGROUND & PREPARATION

My Products*

My Products