The introductory chemistry sequence is a common pathway for undergraduates pursuing science, technology, engineering, and math (STEM) and prehealth careers. Student's academic decision-making has far-reaching consequences for their trajectory, including persistence in the major and ultimate career choice. This phenomenon was studied using a survey and focus group interviews, which were conducted to better understand the factors that influenced student choice. Results were analyzed using exploratory factor analysis, from which personal and institutional factors were identified. Using binary logistic regression, we found that students who placed importance on institutional factors (placement test results, discussion with advisor, academic plans, course load, and confidence in preparation) were more likely to comply with their placement recommendation, whereas students who placed importance on personal factors (family and financial concerns, advice from friends and family, rumors about the course, and nonacademic obligations) were more likely to deviate from their placement recommendation. Focus group interviews were analyzed using the constant comparison method and supported the quantitative findings.