Center for Global Engagement & Buffet Center at Northwestern University

Northwestern's GESI Program Interest Survey 2013

• I. PERSONAL INFORMATION

• Name * First Last
• College or University *
• Email *
• Phone Number * ### - ### - ####
• Address
  Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
• Major
• Second Major (if applicable)
• Minor (if applicable)
• Would you like to be added to our mailing list to receive important GESI updates and newsletters *

  Yes No

• II. DEVELOPMENT SECTOR INTEREST

• Please indicate your top three areas of interest: *

  Microcredit Economic/livelihoods development Education and Youth Environmental Issues Global Health HIV/AIDS Social Entrepreneurship Women's Issues
• Do you have any other areas of interest that we didn't list? Please write them below.

• III. REGIONAL INTEREST

• What country are you interested in? Check all that apply *

  Uganda India Bolivia Nicaragua South Africa Dominican Republic & Haiti
• What would be your dream location to do GESI? (list up to two countries that aren't currently offered)
• Given the choice, which environment would you prefer for your GESI placement? *

  Rural Urban No preference

• IV. OTHER

• How did you hear about GESI? *

  GESI Alumni (please specify the individual(s) in the box below) School Study Abroad Office Info Session Email Flyer (specify the group/department that sent the flyer in the box below) Web Search Google Ad Facebook Ad College Advisor or Professor (please specify the individual(s) in the box below) Career Services Fair (study abroad fair, internship fair, etc.) Student group (please specify in box below) Other (please specify in the box below)
• Would you be interested in a phone call from GESI staff or alumni? *

  Yes No
• What would be the barriers to your participation in GESI? Check all that apply. *

  Financial need I won't get enough credit I might get a paid internship in the summer I don't really know what I will do next summer -- I'm just browsing Other (please specify in the box below)
• Are you considering any other study abroad programs? Check all that apply. *

  Yes, I am considering other summer study abroad programs (please list program name(s) in the box below) Yes, I am considering semester study abroad programs during the regular academic year (please list program name(s) in the box below) No, I am only considering GESI

• Thank you for your interest in GESI! We look forward to getting to know you better.

• Do Not Fill This Out