AT-LARGE GATEWAY
At-Large Regional Policy Engagement Program (ARPEP)
ALAC Liaisons and Representatives
At-Large Review Implementation Plan Development
Page History
CSS Stylesheet |
---|
#editPageLink {display: none !important;} |
At-Large Statement of Interest (SOI) Form
1) Please enter your Name:Gnanajeyaraman Rajaram |
| |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
2) Picture/Image: |
| |||||||||||
3) Are you participating in the At-Large advisory process (including email and real-time discussions) as a representative of: | ||||||||||||
a) ALAC (if so, detail the region and term): |
| |||||||||||
b) A Regional At-Large Organization (RALO) (if so, please detail the region, position and term): |
| |||||||||||
c) An ICANN-accredited At-Large Structure (if so, which one): |
| |||||||||||
d) Any ICANN Committee, Constituency or Stakeholder Group (if so, which one(s))? |
| |||||||||||
e) Any other company or organization, whether commercial or nonprofit (if so, please detail the organization and your position): |
| |||||||||||
4) Please identify your current employer(s): |
| |||||||||||
5) Please identify your current position(s): |
| |||||||||||
6) Please identify the type(s) of work performed: |
| |||||||||||
7) Please identify your declared country of primary residence: |
| |||||||||||
8) Please list any financial relationship beyond de minimus stock ownership you may have with any company that to your knowledge has a financial relationship or contract with ICANN: |
| |||||||||||
9) Please identify any other relevant arrangements, interests, or benefits as requested in the following two questions: | ||||||||||||
a) Do you, your employer, and/or sponsor have any type of material or financial interest in the At-Large advisory process and its outcomes? |
| |||||||||||
If the answer is “Yes,” please describe the interest: |
| |||||||||||
b) Are there any arrangements/agreements between you and any other group, constituency or person(s) regarding your participation as a work team member? |
| |||||||||||
If the answer is “Yes,” please describe the arrangements/agreements and the name of the group, constituency, or person(s): |
| |||||||||||
10) Please identify any Working Groups or other chartered teams in which you are participating (include acronyms, if applicable): |
| |||||||||||
11) Additional information (optional): |
| |||||||||||
12) Page last revised: |
| |||||||||||
=========================== |
At-Large SOI Template v3 (Feb 2014)