Name:

Organization:

Telepone Contact:

E-Mail Address:

My Title, Rank or Position:

My Mission & Purpose in our Organization (1-2 lines):

What I really DO (not a job or position title, 1-2 lines):

Discoveries I've made about innovation in the Workplace(s):

Some challenges I face that require different thinking (2-3 items):

(A "challenge" is a difficulty, but within my ability to influence or take on and change)

Some critical issues in our organization that need innovation (2-3 items):

(An "issue" is a difficultythat requires my teammates an/or leadership's assistance in addition to my ability to influence or overcome)

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

What training classess or conferences have you attended related to innovation, creativity, change, thinking or tea,s (e.g. TQM, Leadership School, ISO 9000, Lean-6 Sigma, ACA COnference, CPSI, Think 101):

Some new skills I would like to learn in the Innovation Ground School:

Some obstacles to innovation in out organization are:

A "Mess" that I would like to work on during the Innovation Ground School:

Results ! Some specific results I hope to bring back from this innovation Ground School

Temperament: If you know your Temperament, please indicate it below. If you do not know your temperament, please click on the link below to go to the Keirsey website to complete the Keirsey Temperament inventpory before entering your Temperament

-- Keirsey Temperament Sorter II --

Temperament
Idealist Rational Guardian Artisan