Please use the <Edit Contents> menu option (directly above) to complete this form. Remember to <Save> the page (bottom right) after making updates. Other than the two required fields immediately below, you may complete any portion of this form, save, and return later to continue where you left off.

Trip Proposals must be completed at least six (6) weeks before the event start date.

Person Completing Form:Jose Ovidio SALGUEIRODate:

08-May-2015

STAFF USE ONLY
Application
Status 
Assessment
Due-Date 
Form ID #
APPROVED

17-Jul-2015

LAC04

Trip Proposal Section

1) Number of Travelers:
(Note: Each traveler uses one trip of the five (5) allocated to each organization/structure).  

1

2) Traveler Contact Information and Itinerary:

TravelerEmailFrom
City
From
Country
Depart
Date
Return
Date
Jose Ovidio SALGUEIROsalgueiro.jo@gmail.comCaracasVenezuela22-Jun-201529-Jun-2015
3) Special Travel Circumstances, Arrangements,
Explanations, or Notations: 
(Please identify each traveler, as applicable)
I´ll pay my own expenses for the days not covered by ICANN
4) Event/Conference Name, Title, or Descriptor:ICANN 53
5) Event/Conference Dates:
Start:21-Jun-2015End:25-Jun-2015
6) Event/Conference Website Link:https://buenosaires53.icann.org/en/
7) Primary Event/Conference Location:
Street
Address:
Sheraton Hotel Buenos Aires San Martin 1225
City:Buenos AiresCountry:Argentina
8) ICANN Geographic Region:Latin America and Caribbean

9) Activity Sponsors:
(Note: all event sponsors must be identified
in order to comply with ICANN travel guidelines).


CROPP Program

10) Purpose and Goals:

Learn more about current ICANN an RALO activities in order to perform better outreach in my country through my ALS´s activities Join an At-Large Working Group Collaborate with the Chair and Secretary in meetings Any other that may arise from the region´s needs

11) Proposed Outcomes:Becoming involved once again in At-Large and attending and participating in RALO monthly calls. Getting prepared for outreach activities; talking about ICANN and LACRALO in events where my ALS in participating; attracting new community members to our ALS; Increment participation of fellow countrymen in LACRALO
12) Additional Information (optional):

Community Confirmation Section

Note: To be completed by a Pilot Program Coordinator (PPC) designated by this organization/structure.

AcknowledgementsConfirmed?NameDateNotes
The participants identified in this application are familiar with the Program Operations associated with this Community Regional Outreach Pilot Program (CROPP)-FY15 and agree to abide by its terms and conditions.YesDev Anand Teelucksingh18-May-2015
The ICANN Organization / Structure's leadership has authorized the submission of this Trip Proposal.YesDev Anand Teelucksingh18-May-2015
The ICANN Stakeholder Engagement Vice-President has concurred that the Purpose/Goals of this Trip Proposal are consistent with operational plans and/or strategies.YesDev Anand Teelucksingh18-May-2015
  =======================================================

 


 

Program Administration: STAFF USE ONLY
Program RequirementDate Satisfied/ConfirmedInitialsNotes
Constituency Travel Notified18-May-2015JDLADDT'L NIGHTS COVERED BY TRAVELER
Trip Proposal Approved and
Transferred to Official Forms: 
19-May-2015Trip Assessment Approved and
Transferred to Official Forms: 
24-Sep-2015


CROPP Application Template v8 (May 2014)

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