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:Test PersonDate:

27-May-2014

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

30-Aug-2014

SAMPLE

Trip Proposal Section

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

2

2) Traveler Contact Information and Itinerary:

TravelerEmailFrom
City
From
Country
Depart
Date
Return
Date
John Q. Travelermailto:jqtrav@anywhere.orgDallasTX (USA)05-Aug-201407-Aug-2014
Susan P. Participantmailto:spart@anywhere.orgLos AngelesCA (USA)06-Aug-201407-Aug-2014
3) Special Travel Circumstances, Arrangements,
Explanations, or Notations: 
(Please identify each traveler, as applicable)
Susan is local to the event and does not require airfare/lodging reimbursement - only the registration fee.
4) Event/Conference Name, Title, or Descriptor:Conference name
5) Event/Conference Dates:
Start:05-Aug-2014End:08-Aug-2014
6) Event/Conference Website Link:http://www.conferencename.com
7) Primary Event/Conference Location:
Street
Address:
1000 Independence Avenue
City:Los AngelesCountry:CA (USA)
8) ICANN Geographic Region:North America

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


Sponsors:

  • Sponsor 1
  • Sponsor 2
  • Sponsor 3
  • Sponsor 4

 

10) Purpose and Goals:

Purpose and goals described here...

11) Proposed Outcomes:Proposed outcomes documented here...
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.YesPPC Name20-May-2014
The ICANN Organization / Structure's leadership has authorized the submission of this Trip Proposal.YesPPC Name21-May-2014
The ICANN Stakeholder Engagement Vice-President has concurred that the Purpose/Goals of this Trip Proposal are consistent with operational plans and/or strategies.NoPPC Name22-May-2014Pending approval by Joe Catapano.
  =======================================================

 


 

Program Administration: STAFF USE ONLY
Program RequirementDate Satisfied/ConfirmedInitialsNotes
Trip Assessment Approved and
Transferred to Official Forms: 


CROPP Application Template v8 (May 2014)

  • No labels
For comments, suggestions, or technical support concerning this space, please email: ICANN Policy Department
© 2015 Internet Corporation For Assigned Names and Numbers