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Trip Proposal Section

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

Number Data

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

2) Traveler Contact Information and Itinerary:

Table Data

name	CONTACTINFO
initialRows	1

Traveler	Email	From City	From Country	Depart Date	Return Date
TRAVELER1linetextBLOCK	T-EMAILlineBLOCK	FROM1linetextBLOCK	FROM2linetextBLOCK	01-Jul-2016dd-MMM-yyyyDEPARTBLOCK	dd-MMM-yyyyRETURN30-Jun-2017BLOCK

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

Text Data

name	SPECIAL
width	650px
content	text

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

Text Data

name	EVENT
content	text

5) Event/Conference Dates:

Start:

Date Data

format	dd-MMM-yyyy
name	START

End:

Date Data

format	dd-MMM-yyyy
name	END

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 Global Stakeholder Engagement Region:

List Data

name	REGION

AAfrica

BAsia

CAustralasia/Pacific Islands

DEurope

ELatin America and Caribbean

FMiddle East

GNorth America

HEastern Europe

and Central Asia

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:

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Content Guidelines (click here)

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Please develop specific goals/outcomes for as many of the following categories as applicable:

1) Workshops/Seminars/Presentations including roles (e.g., speaker, facilitator, organizer), relevant content, literature to be disseminated, and specific purposes/objectives.

2) Engagement/Outreach including broadening awareness of ICANN in targeted regional areas (e.g., under-represented).

3) Recruitment including formal/informal invitations to become involved in ICANN stakeholder communities, working groups, and/or fellowship programs.

4) Fulfillment of documented Outreach Strategic Plans and/or ICANN Regional Strategies.

5) Knowledge Sharing including intentions to extend learnings within and among ICANN stakeholder communities.

Text Data

name	GOALS

11) Additional Information (optional):

Text Data

name	ADDTLINFO

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

Panel

titleColor	navy
titleBGColor	lightyellow
title	Acknowledgements Section

Note: The first three elements below should 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 FY17 Community Regional Outreach Pilot Program (CROPP) as outlined on the CROPP Procedures & Guidelines page.

List Data

name	ACK-1

AYes

BNo

Text Data

name	ACKNAME-1
type	line
content	text

Date Data

format	dd-MMM-yyyy
name	ACKDATE-1

Text Data

name	ACKNOTES-1
width	300px
content	text

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

List Data

name	ACK-2

AYes

BNo

Text Data

name	ACKNAME-2
type	line
content	text

Date Data

format	dd-MMM-yyyy
name	ACKDATE-2

Text Data

name	ACKNOTES-2
width	300px
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

AYes

BNo

Text Data

name	ACKNAME-3
type	line
content	text

Date Data

format	dd-MMM-yyyy
name	ACKDATE-3

Text Data

name	ACKNOTES-3
width	300px
content	text

The CROPP Staff Administrators confirm that this trip/event satisfies the program's terms, guidelines, and policies.

List Data

name	ACK-4

AYes

BNo

Text Data

name	ACKNAME-4
type	line
content	text

Date Data

format	dd-MMM-yyyy
name	ACKDATE-4

Text Data

name	ACKNOTES-4
width	300px
content	text

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

==========

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

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bgColor	lightyellow
titleColor	maroon
titleBGColor	lightcyan
title	Program Administration: STAFF USE ONLY

Approved Travel Elements:

Table Data

name	TRAVELAPPROVAL
initialRows	1

Traveler

Approved
Arrival Date

Approved
Departure Date

Approved Fees

ATRAVELERlinetextBLOCK

dd-MMM-yyyyADEPARTBLOCK

dd-MMM-yyyyARETURNBLOCK

trueFUNDEDchecknewlineINLINEAAirfare

BHotel/Lodging

CPer Diem

DVisa

ERegistration

Staff Department Notifications:

Table Data

name	REQUIREMENTS
initialRows	1

Program Requirement	Date Satisfied/Confirmed	Initials	Notes
RQMTBLOCKASpeakers Bureau BCommunications Department CMeetings Team DConstituency Travel Notified ETravel Booking Initiated with Attendees FTravel Booking Completed/Confirmed GProgram Criteria Satisfied HOther Disposition	dd-MMM-yyyySATISFIEDBLOCK	INITIALS50pxBLOCKAJDL BRH CBR EJDJ FKB	NOTES300pxtextBLOCK

Program Admin Transfers from Community Drafts to Approved Forms:

Trip Proposal

Date Data

format	dd-MMM-yyyy
name	P-POSTED

Trip/Event Assessment

Date Data

format	dd-MMM-yyyy
name	A-POSTED

...

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Old Version 14

New Version 15

Key

Trip Proposal Section

Approved Travel Elements:

Staff Department Notifications:

Program Admin Transfers from Community Drafts to Approved Forms: