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Section A: Identification, Contact Information, Resume, and Professional References | |||||
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1) Name: |
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Picture/Image (Optional):
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Cloak |
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Click in the field to the right to open up the text input window. Then click the <"+" Insert more content> menu button, select <Image>, then choose (or browse) to locate an image file (e.g., JPG, PNG, BMP) from your local computer to upload. After insertion, please click on the picture and adjust the size to no larger than 200 pixels. |
2) Gender:
3) Email Addresses:
Primary: | |
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Alternate: |
4) Telephone/Contact Numbers:
Instructions Toggle Cloak
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Please include all international, country, and city/area codes, e.g., +64 1111 2222. Use the "+ Add Row" to add additional rows to the table; the "x" can be used to delete rows added by mistake. |
Type | Number (or ID) |
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5) Country of Citizenship:
If you have multiple citizenships, please list them comma-separated.
6) Domicile:
Instructions Toggle Cloak
Cloak |
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Domicile means the country that you treat as your permanent home, or live in and have a substantial connection with. If you reside in more than one country, please state the percent of time you reside in each country as a whole digit number without the '%' sign. Use the "+ Add Row" to add additional rows to the table; the "x" can be used to delete rows added by mistake. |
Country | Percent |
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7) If you have a personal Web page, Blog, Facebook, Twitter or YouTube Channel, you may provide links here.
Instructions Toggle Cloak
Cloak |
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Click inside the text box to open the input window. Highlight one of the bullets; then, from the top menu, select Link, choose Web Link, then enter the information. You may alter the appearance in the "Link Text" field or accept the default. Click Done and the information will be inserted as automatically linkable. |
- Link1
- Link2
- Etc.
8) Resume:
If you have a resume or curriculum vitae (C.V.), the Committee would appreciate having it uploaded it to this page (PDF preferred) and then linked within this question. Your uploaded resume should not exceed the equivalent of five (5) single-spaced typewritten pages.
Instructions Toggle Cloak
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Click inside the text box (right column) to open the input window. On the top menu, click the <"+" Insert more content> menu button; select Attachment; then use the Choose File (or Browse) option to locate the document on your computer. You may alter the link's appearance by adding a description in the "Link Text" box at the bottom of the window. |
9) Professional References:
Explanation
Instructions
Name | Telephone | Relationship | Years Known | |
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Section B: Qualifications & Professional BackgroundPurpose of This Section | |||||||
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1) Please describe any current and past volunteer positions, roles, and accomplishments. The Committee is particularly interested in Board or similar directorship experience. Please include the name and web page of such organizations, if applicable. | |||||||
2a) Have you held or do you currently hold a Board or executive management position in any organization? | |||||||
2b) If "Yes," please state the nature and size of the organization(s) in which you currently hold or have held a Board or executive management position. | |||||||
3a) Do you have experience working with non-profit organizations? | |||||||
3b) If "Yes," please state the nature and size of any non-profit organization(s) including any Board positions or executive committees upon which you currently serve or have served. | |||||||
4) Briefly describe any experience you have had working with groups in various locations and time zones around the globe. | |||||||
5) Being able to read and to express yourself publicly in English is mandatory for leadership positions at ICANN. Do you meet this criterion? | |||||||
6) Which other languages do you speak and at what level of fluency? Instructions |
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Section C: Internet & ICANN Involvement | |||||||
1) Describe your current and past involvement in, contributions to, and leadership roles in activities and organizations involved in the development and operation of the Internet, its naming and addressing infrastructure, and/or its security and stability. Explanation | |||||||
2) Conflicts of Interest Instructions | |||||||
3) Please explain any positions you hold as Director, major shareholder, or employee of a Generic Top Level Domain (gTLD) Registrar or Registry, Country Code Top Level Domain (ccTLD) Registry or a Regional Internet Registry (RIR). | |||||||
Section D: Application for At-Large Board Member Position | |||||||
1) Please state your opinion about what would be your unique expertise or perspective and what added value you might contribute to the ICANN Board: | |||||||
2) Please describe how and why you meet the criteria for this position: Instructions | |||||||
3) Please state what you would contribute in the At-Large selected ICANN Board Member Position to the At-Large Community | |||||||
4) Please describe specifically how and why you will be able to advance, at the ICANN Board, the interests of the At-Large Community and the broader global community of Internet end-users. | |||||||
5) Time Commitment: Explanation Are you able to commit this amount of time for this position? | |||||||
6) Please describe your understanding of changes to ICANN's Bylaws, organizational structure, and accountability mechanisms that have been put in place as part of the transition of the stewardship of IANA functions. Please also describe any personal involvement you have had in these changes. | |||||||
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