Please provide the following contact information:

Name
Country
Work Phone
E-mail

Non-Disclosure

The issue of non-disclosure is paramount to this relationship.  Our understanding is that nothing in this system is to be discussed outside of the permissions granted to you based on your license.  A non-disclosure form will be signed upon your acceptance into the Spiral-NEXT System.

PLEASE indicate your comfort level with this level with non-disclosure and express your concerns in the space below.

Reason for Application

List in as few a words as possible the specific reason you chose to apply:

 Please write up to 250 words explaining what you would like to target in the program as a specific result you would like to get from the training:

At what level in organizations have you worked before:

Enterprise Level [C Level, or MD level]
Group Level [Senior VP]
Business Unit Level [VP, MD, GM]
Functional Level [VP]
Managerial Level
Supervisory Level

Other

If other:

Please choose the highest U.S. dollar level correlated to a budget you oversaw, managed or worked with someone who managed:

<1 million
1-5 million
5-10 million
100 million
500 million
1 billion
>1 billion

Have you completed any of the following assessments:

(Check all that apply)

Representational Styles [Visual, Auditory, Kinesthetic, Auditory Digital]
Success Insights: Personal Interests Attitudes & Values
Success Insights; DiSC or equivalent
Myers-Briggs: If yes, please enter 4 letter type
Myers-Briggs Step II
Reiss Profile of Motivational Sensitivity
Change State Indicator
Thomas-Kilmann Conflict Mode
Kolb Learning Styles
Personal Values Quotient
Kolbe Connative Index
Birkman
Other

If other:

Delivery of Training

How would you like to receive feedback, inquiry, challenges and ideas in the program?

Strategic Information:

List your strengths:

List your limitations:

List the opportunities you feel you have:

List any threats you feel are present now:

List or describe the values that you honored in the past:

Since these values are about the past, are there new values you aspire to?

Describe your vision of the future:

List all the cliché’s/axioms in your life regarding your guiding principles:

(In other words, what statements of principle do you live your life by?

Examples:

Treat others the way that you would want to be treated
People are right until proven guilty
I don’t trust anyone, they have to earn my trust
 

List 1 Goal for each of the following areas of your life or business, or both:
 
PERSONAL:

BUSINESS:

List the goals or ideas about the future you have currently around being, doing, having, and becoming over the next 3-6 months:

List the goals or ideas about the future you want to accomplish or be in the next two years:

List the goals or ideas about the future you want to accomplish or be in your lifetime:

What style of feedback do you prefer? (gentle, challenging, provocative, direct, indirect, etc.)

If there was anything you could change in your life right now, and there were no constraints on anything, what would you change now:

Describe what it's like when you're at your best:

Any comments you'd like to share:

After you click Submit Form, you will be taken to the payment page. If your application is not approved, we will void, or refund your payment immediately.

Thanks for your effort!