Name:

Company:

My Mission & Purpose:

Title/Area of Responsibility:

Work Mailing Address:

Home Mailing Address:

Work Telephone Number(s):

Home Telephone Number(s):

Fax Number:

Work E-Mail Address:

Home E-Mail Address:

1. Who referred or recruited you, or how did you learn about this School for Innovators (1-2 Lines):

2. Why I want to go on Expedition with the School for Innovators (2-3 Lines)

3. Unusual skills and experience I bring to the School (3-4 items)

4. Some unusual adventures I have been on (3-4 Lines)

5. Some useful insights and discoveries I have made in life (2-3 Lines)

6. A little known fact about me (Almost nobody knows this) (1-2 Lines)

7.

Temperament
Idealist Rational Guardian Artisan

If you do not know your Temperament, please click on the link below to go to the Keirsey website to complete the Keirsey Temperament inventory.

8. Some critical issues and challenges I face (3-5 Items)

9. Some obstacles to innovation in our organization are (3-5 lines):

10. List any creative thinking and innovation tools and/or techniques you use regularly or are familiar with:

11. What training classes or conferences have you attended related to innovation, creativity, change, and teams (e.g. TQ, quality, ISO 9000, 6 Sigma, CPSI)

12. Some new skills I would like to learn are (3-5 items):

13. Some things that I often find stressful are (2-3 Things)

14. Unknowns I hope to explore on expedition are (3-4 Items)

15. The MESS - The strategic focus I will bring to the School (3-4 lines):
[NOTE: A "Mess" is a complex collection of inter-related issues, problems, challenges, opportunities, background and history facing you and your organization - and is something YOU are interested in working on]

16. Some specific results I hope to return with (2-3 Results)

NOTE: School for Innovators Expeditions are mentally and physically intense. The days start early and end late, with the team's excitement and energy often driving the group - midnight is not unusual. Meals and breaks are largely unscheduled, taken when the opportunity presents itself. Basecamp is at 7,500 feet and outdoor activities sometimes move to as high as 12,000 feet. All that being said, if you are able to handle a brisk two or three mile walk at home, you should be able to participate fully. A daily walk of two to three miles is the best way to prepare yourself physically for the outdoors work. Conditions ranging from diabetes to four months pregnant to multiple sclerosis have not limited participation in the School for Innovators.

Every School for Innovators is tailored to fit the profile of the group. Answering the following questions will help us begin that assessment:

17. Please list the sports/exercise/fitness programs in which you regularly engage?

18. Please provide a brief history of back, knee, or shoulder problems, heart, respiratory conditions, altitude sickness, or any other conditions which you feel might effect your performance on the expedition?

19. Please list any major sicknesses, illnesses, or operations you have had in the last six months?

20. Please list any dietary constraints (foods you cannot eat)?

This VISA is the first step in your nomination process for joining an upcoming School for Innovators Expedition. Once we have received and processed your VISA Nomination (initial application), we will send you more detailed information about Expedition XLVIII and additional pre-work.

I hereby apply to participate in the School for Innovators Expedition that is scheduled for July 2008. I realize that as a member of the team I am committed to finishing the Expedition - the team can count on me.

Should you have any questions or difficulties, please call the School for Innovators, Fredericksburg, Texas at (830) 992-2153 or send an e-mail to: basecamp@thinking-expedition.com