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STAFF USE ONLY
Application
Status  		Assessment
Due-Date 		 Assessment
Status 

Trip Proposal Section

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

Traveler Email (Redacted) Alternate Email (Redacted)
2) Application Date:

3) Dates of Requested Travel:
Departure:
Return:

4) Travel Itinerary:
From City: Country:
To City: Country:
Other:
 (Describe)
5) Event/Conference Name, Title, or Descriptor:
5a) Event/Conference Website Link:
6) Primary Event/Conference Location:
7) ICANN Geographic Region:

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


9) Purpose and Goals:

10) Proposed Outcomes:
11) Additional Information (optional):

ACKNOWLEDGEMENTS (Required):

The participants identified in this application are familiar with the Program Operations associated with this Community Regional Outreach Pilot Program (FY14) and agree to abide by its terms and conditions.

The ICANN Organization/Structure's leadership has authorized the submission of this Trip Proposal.
The ICANN Stakeholder Engagement Vice-President has concurred that the Purpose/Goals of this Trip Proposal are consistent with operational plans and/or strategies.

Trip Assessment Section

1) Describe how the original Purpose and Goals were accomplished:

2) Describe how the original Outcomes were achieved:

 
3) Date Completed:
4) Additional information pertaining to this outreach event (optional):
  =============================================
Program Administration: STAFF USE ONLY
Program Requirement Date Satisfied Initials Notes
Confirmation Section: STAFF USE ONLY
Program Administrator Confirmed? Date Rationale

CROPP Application Template v5 (Sep 2013)

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