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SOAC/E Archive:

> CROPP-FY16
> CROPP-FY15
> CROPP-FY14
> Outreach & Engagement: FY14

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Trip Proposal Section

LINK: AFRALO Trip/Event Assessment 6 DRAFT

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

Number Data

minValue	1
maxValue	5
width	100px
name	TRIPS
format	###

2) Traveler Contact Information and Itinerary:

Table Data

name	CONTACTINFO
initialRows	1

Traveler	Email	From City	From Country	Depart Date	Return Date
textTRAVELER1BLOCKline	T-EMAILBLOCKline	textFROM1BLOCKline	textFROM2BLOCKline	DEPARTdd-MMM-yyyyBLOCK	RETURNdd-MMM-yyyyBLOCK

3) Special Travel Circumstances, Arrangements,
Explanations, or Notations:
(Please identify each traveler, as applicable)

Text Data

width	650px
name	SPECIAL
content	text

4) Event/Conference Name, Title, or Descriptor:

Text Data

name	EVENT
content	text

5) Event/Conference Dates:

Start:

Date Data

name	START
format	dd-MMM-yyyy

End:

Date Data

name	END
format	dd-MMM-yyyy

6) Event/Conference Website Link:

Text Data

name	LINK

7) Primary Event/Conference Location:

Street
Address:

Text Data

name	ADDRESS
content	text

City:

Text Data

name	CITY
type	line
content	text

Country:

Text Data

name	COUNTRY
type	line
content	text

8) ICANN Geographic Region:

List Data

name	REGION

AfricaA

AsiaB

Australasia/Pacific IslandsC

EuropeD

Latin America and CaribbeanE

Middle EastF

North AmericaG

Russia/CIS/Eastern EuropeH

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

Text Data

name	SPONSORS

10) Proposed Goals and Outcomes:

Text Data

name	GOALS
content	text

11) Additional Information (optional):

Text Data

name	ADDTLINFO

=======================================

Panel

titleColor	navy
titleBGColor	lightyellow
title	Community Confirmation Section

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

Acknowledgements

Confirmed?

Name

Date

Notes

The participants identified in this application agree to abide by the terms and conditions of this FY16 Community Regional Outreach Pilot Program (CROPP) as outlined on the Program Elements page.

List Data

name	ACK-1

YesA

NoB

Text Data

name	ACKNAME-1
type	line
content	text

Date Data

name	ACKDATE-1
format	dd-MMM-yyyy

Text Data

width	300px
name	ACKNOTES-1
content	text

The ICANN Organization / Structure's leadership has authorized the submission of this Trip Proposal.

List Data

name	ACK-2

YesA

NoB

Text Data

name	ACKNAME-2
type	line
content	text

Date Data

name	ACKDATE-2
format	dd-MMM-yyyy

Text Data

width	300px
name	ACKNOTES-2
content	text

The ICANN Stakeholder Engagement Vice-President has concurred that the Proposed Goals/Outcomes of this Trip Proposal are consistent with operational plans and/or strategies.

List Data

name	ACK-3

YesA

NoB

Text Data

name	ACKNAME-3
type	line
content	text

Date Data

name	ACKDATE-3
format	dd-MMM-yyyy

Text Data

width	300px
name	ACKNOTES-3
content	text

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