The Public Sector Innovation Journal

About Us What's New Search Site Volumes & Issues Français Contact

Innovation Journal > News >

Form


The information you provide to us will be made available to others
through the Directory.

(1) NAME:___________________________________

(2)TITLE:____________________________________

(3) ORGANIZATION:______________________________

(4) ADDRESS:______________________________

(5) CITY:____________________________
(6) PROVINCE:______

(7) PC ____________________

(8) PHONE:_______________________
(9) FAX:_____________________

(10) E-MAIL:____________________________

(11) WEB SITE: _________________________________



(12) I consider myself to be a PROFESSIONAL futurist:

(a) YES:____ (b) NO:____.



(13) Indicate the number of years you have been paid as a futurist:

(a) 1___, (b) 2 - 5___, (c) 6-10___, (d) 11-20___, (e) 21-30___,
(f)30+___.



(14) Today, I work as a futurist: (a) full time: ____, or (b)
part-time:____.



(14.1) If you work part-time, indicate the % of your total paid work
time which you devote to serious futures work:_____%



(15) I work in: (a) English____, (b) French____, (c) Other (specify)

___________________________________________



16) Summary statement:_______________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________



(17) I work entirely within my organization: (a) YES:____ or (b)
NO:____



(18) I have clients outside my organization drawn from the following
sectors:

(a) Fortune 500 companies ____,
(b) small & medium enterprises ____,
(c) federal government(s)____,
(d) provincial/state government(s)____,
(e) municipal government(s)____,
(f) education____,
(g) health____,
(h)voluntary organizations____,
(i) churches____,
(j) political parties____,
(k) individual persons____,
(l) other (specify)_________________________________



(19) I now have, or have had, clients in the following areas:

(a) in my local area____, (b) across my province____, (c) in
neighbouring provinces____, (d) across Canada____, (e) in the
USA____, (f) in Europe____,

(g) in the Middle East____, (h) in Asia____, (i) in Africa____, (j)
in Latin America____, (k) other (specify)

________________________________________________



(20) I have developed competence in the following futures methods:

(a) environmental scanning____, (b) technology forecasting____, (c)
social forecasting____, (d) scenario creation ____, (e) Delphi
surveys_____,

(f) search conferences_____, (g) historical analysis____,
(h) paradigm / world view analysis____,
(i) trend tracking /analysis____,
(j) systemic futures thinking____, (k) other (specify)
____________________________________________

______________________________________



(21) I have developed competence in the following topics / areas:

(a) history of futures thinking___, (b) futures methodologies___,
(c)cultural transformations___, (d) societal change___,
(e) organizational change___, (f) personal change___,
(g) leadership___,
(h) governance___, (i) politics___,

(j) science___, (k) bio-technologies___, (l) information /
communications technologies___, (m) families___, (n) religion /
spirituality / world views___,

(o) globalization___, (p) sustainability___, (q) defence___, (r)
environment___, (s) energy___, (t) food / agriculture___, (u)
health___, (v) education / learning___, (w) urban life___, (x) rural
life___, (y) economic development___,
(z) community development___,
(A)crime / justice___,
(B) other topics
(specify)________________________________



(22) I offer the following future oriented services:

(a) futures research___,
(b) technology forecasting___,
(c) economic

forecasting___, (d) social forecasting___, (e) trend analysis___,

(f) scenario creation___, (g) strategic briefings___,
(h) keynote addresses___, (i) seminars / workshops___,
(j) meeting conference

design___, (k) meeting facilitation ___,
(l) meeting / conference organization / administration___,
(m) consulting___, (n) coaching___,

(o) project design___, (p) project management___, (q)

ongoing learning group(s)___, (r) simulations___, (s) other

(specify) _______________________________________________
_______________________________________



(23) I offer the following futures oriented products: (check ALL

appropriate)

(a) books___, (b) newsletter___, (c) software___, (d) data
base(s)___,

(e) other (specify)

__________________________________________________
_________________________________________________



(24) I have worked on the following major futures
research projects (include the year and your role).

(a) __________________________________________________
(b) _________________________________________________
(c) __________________________________________________



(25) I have spoken on the future at the following major events
(include

the year).

(a) ____________________________________________
(b) ____________________________________________

(c) ______________________________________________



(26) I teach / have taught the following futures courses / seminars
(in

clude organizational setting, if any).

(a) _________________________________________________

(b) _________________________________________________

(c) _________________________________________________



(27) I have written the following futures books / articles (include
year).

(a) __________________________________________________

(b) __________________________________________________

(c) _________________________________________________



(28) I am a member of the following futures-oriented organizations.

(a) _____________________________________________
(b) _____________________________________________

(c) _______________________________________________



(29) I am a Fellow of the following futures-oriented organizations.

(a) ____________________________________________

(b) ____________________________________________

(c) ____________________________________________



(30) The following professional futurists recognize me as a
colleague.

(a) ____________________________________________

(b) ____________________________________________

(c) ____________________________________________



(31) Additional information, comments or
reflections_____________________

_______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________



THANK YOU!

PLEASE SEND COMPLETED FORM TO:
Ruben Nelson rubenn@squareone.ca
or FAX to (403)-673-2114


Updated November 09, 1998