Name:

Company:

My Mission & Purpose:

Title/Area of Responsibility:

Work Mailing Address:

Home Mailing Address:

Work Telephone Number(s):

Home Telephone Number(s):

Work E-Mail Address:

Home E-Mail Address:

[NOTE: For privacy, a copy of your completed eVISA will be sent to this e-mail address only]

1. Why do you want to go on Expedition with the School for Innovators (2-3 Lines):

2. Some unusual skills and experience I bring to the School (3-4 items):

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

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

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

6.

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.

7. My Myers Briggs Type - MBTI (if known):

8.

My KAI Style (Kirton Adaption-Innovation inventory) and subscores:
Total    O-score    E-score    R-score    Sorry, I don't know my KAI

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

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

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

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

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

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

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

16. 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]

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

18. 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 initial eVISA application we will send you more detailed information about Expedition XLIX, logistics, travel, and some additional pre-work.

I hereby apply to participate in the Thinking Expedition that is planned for February 2010. Note that completing this eVISA does not obligate you in any way. It is a planning document only.

Signature/Date (Your e-mail reply will suffice for this entry)

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