General Intake Form
Visitor Information
Please enter the following information so that we can forward your request to the appropriate Dean.
First Name
Last Name
GT Account (Prism ID)
Preferred Email Address (If different from GT Email Address)
Contact Preference
Primary/Secondary Phone
Cell Phone
GT Email Address
Preferred Email Address
Primary Phone Number
Secondary Phone Number
Cell Phone Number
Have you ever seen a Dean?
Yes
No
If yes, name of Dean?
Reason for Visit
How would you best describe your reason for wanting to visit with the Dean of Students Office? Please choose one primary reason and at most two secondary reasons.
Academic
Academic Drop Related
Primary
Secondary
Problem with a class or instructor (list class in Other section)
Primary
Secondary
Withdrawal
Primary
Secondary
Incomplete Related
Primary
Secondary
Faculty member did not follow the honor code
Primary
Secondary
Class Absence(s)
Need Excuse for Institute Approved Activity
Primary
Secondary
Unique Academic
Primary
Secondary
Need Excuse for Funeral Attendance
Primary
Secondary
Academic Withdrawal Related
Primary
Secondary
Need Excuse for Personal Issues
Primary
Secondary
Excuse - Other
Primary
Secondary
Unique Problem
Harassment Related Issue
Primary
Secondary
Discrimination Related Issue
Primary
Secondary
Student Organizations Related Issue
Primary
Secondary
Assault Related Issue
Primary
Secondary
Miscellaneous
Background Check
Primary
Secondary
Recommendation Letter/Form
Primary
Secondary
Financial Distress
Primary
Secondary
Re-admission Advice
Primary
Secondary
Personal Issue Advice
Primary
Secondary
Graduate/Professional School Reference Letter
Primary
Secondary
Other
I am seeking the assistance of the Dean of Students Office for a reason not listed above.
Primary
Secondary
Visit Details
Please include a brief description of the problem in the box at the right. Specifically, if you are reporting a problem with a class or instructor, if you need a class excuse for a unique reason, or if you have a unique problem, please take some time to explain the details here. You may also provide additional details of any issue you are reporting.
Who Referred you to the Dean of Students Office?
Please choose one primary source and at most two secondary sources that may have influenced you.
I referred myself...
I just thought the Dean of Students Office would be the right place.
Primary
Secondary
A web page.
Primary
Secondary
A publication said that this was the place to go.
Primary
Secondary
I did not know where to go.
Primary
Secondary
Other
Primary
Secondary
If Other, please list source.
Someone else referred me...
A student friend recommended.
Primary
Secondary
A faculty member referred me.
Primary
Secondary
A residence hall staff member referred me. (Peer Leader, Community Assistant, etc.)
Primary
Secondary
My parents referred me.
Primary
Secondary
My fraternity/sorority referred me.
Primary
Secondary
Another administrator or campus office.
Primary
Secondary
If another administrator or campus office referred you, please list here.
When finished, click the Submit Intake Form button below. Your request will be forwarded to the Dean of Students Office and you will receive a tracking number. A Dean will then contact you concerning your request.
