2017 Wild Leaders Immersion Application
We invite you to think of this application process as a moment to reflect on yourself and your life and articulate what you’re about, which will surely be useful whether you end up in the program or not. There are no right or wrong responses.

This application may take anywhere from 20 minutes to an hour. Your responses will not be saved until you click Submit at the end. We encourage you to document your responses elsewhere if you will be working on this application over time. A copy of your answers will be emailed to you once submitted.

Accepting applications until full.
Please direct any questions to wildleaders@gmail.com or call Michael Ismerio at 503-808-0362

Email address
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Personal Information
Full Name
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Address
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City
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State
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Zip
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Phone
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Date of Birth
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Skype Name
Might possibly be used to connect before the program. If you don't have one, that's okay.
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How did you FIRST hear about the Wild Leaders Immersion?
Please give specific details, like the location of poster, name of friend, name of facebook page or group, the term you searched for online, etc.
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The Ecology of YOU
This program is based in a holistic, experiential learning model that is designed to be a transformational journey. As you consider embarking on an experience such as this, please answer the following:
Why would you like to participate in the Wild Leaders Immersion out of all the possible things you could be doing in the world?
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What do you hope to gain from participating?
What do you need to walk away with in the end to feel like this was a valuable use of your time and resources?
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If you had to describe yourself as a nature metaphor, what would you be and why?
For example, "I am a rushing river because…"
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What are your leadership goals?
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What excites you most about this program?
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What makes you nervous or brings up concern?
With regards to this program
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What prior experience do you bring with you that you’re excited to build on in the Immersion?
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What aspects of the program are the most new or unfamiliar to you?
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Joining this experience represents a significant commitment, both in time and energy. This kind of commitment requires support. Who are the people in your life that you will call on for this support? What kind of framework or rhythm of support exists between you and these people? Please explain.
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What, if anything, do you want us to know about your dreams & aspirations?
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How can you help us achieve diversity in our program?
For example: Race, gender identity, ethnicity, age, etc.
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Do you have any medical, physical, or psychological conditions that might influence your ability, or require special adaptation, to complete this program?
If you answered 'Yes' to the question above, please explain in the space provided:
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Do you have any dietary needs and/or allergies?
If so, please list them here. If not, write n/a.
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I have read the course calendar and don't foresee any conflict in my ability to attend the entire Immersion.
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If there are scheduling conflicts, please explain.
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How do you plan to finance your participation in the Wild Leaders Immersion?
Select all that apply
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Additional comments or questions on financing
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Please include the names and contact information for two references.
Email and phone
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Please share any questions you have here.
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Please check the box if you want to subscribe to the sponsoring organization's mailing list.
In submitting this form, I certify that to the best of my knowledge the statements I have made in this application are complete and true.
Please complete the captcha before submitting the form.
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