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Trip Proposal Section

1) Traveler Contact Information and Itinerary:

TravelerEmailFrom
City
From
Country
Depart DateReturn Date


Text Data
nameTRAVELER1
typeline
contenttext




Text Data
nameT-EMAIL
typeline




Text Data
nameFROM1
typeline
contenttext




Text Data
nameFROM2
typeline
contenttext




Date Data
formatdd-MMM-yyyy
nameDEPART
 



Date Data
formatdd-MMM-yyyy
nameRETURN
maxDate30-Jun-20192020
 



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


Text Data
nameSPECIAL
width650px
contenttext



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


Text Data
nameEVENT
contenttext



4) Event/Conference Dates:


Start:


Date Data
formatdd-MMM-yyyy
nameSTART
 


End:


Date Data
formatdd-MMM-yyyy
nameEND
 



5) Event/Conference Website Link:


Text Data
nameLINK



6) Primary Event/Conference Location:


Street
Address:


Text Data
nameADDRESS
contenttext



City:


Text Data
nameCITY
typeline
contenttext



Country:


Text Data
nameCOUNTRY
typeline
contenttext




7) ICANN Global Stakeholder Engagement Region:


List Data
nameREGION


AAfrica



BAsia



CAustralasia/Pacific Islands



DEurope



ELatin America and Caribbean



FMiddle East



GNorth America



HEastern Europe and Central Asia




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



Text Data
nameSPONSORS



9) 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
nameGOALS



10) Additional Information (optional):


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nameADDTLINFO
 


11) Consent & Authorization:

By submitting my personal data, I agree that my personal data will be processed in accordance with the ICANN Privacy Policy, and agree to abide by the website Terms of Service.

If you agree to text above, please fill out your name and date in the box on the right.



NameDate


Text Data
nameNAMECONSENT
contenttext
 



Date Data
formatdd-MMM-yyyy
nameDATECONSENT



_______________________________________________________________

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titleColornavy
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titleAcknowledgements Section

Note: The first three elements below should be completed by a Program Coordinator (PC) designated by this organization/structure.

AcknowledgementsConfirmed?Who Confirmed?Date of ConfirmationNotes
The participants identified in this application agree to abide by the terms and conditions of this FY18 Community Regional Outreach Program (CROP) as outlined on the CROP Procedures & Guidelines page.


List Data
nameACK1


AYes



BNo





Text Data
nameACKNAME1
typeline
contenttext




 
Date Data
formatdd-MMM-yyyy
nameACKDATE1



Text Data
nameACKNOTES1
width300px
contenttext



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


List Data
nameACK2


AYes



BNo





Text Data
nameACKNAME2
typeline
contenttext




 
Date Data
formatdd-MMM-yyyy
nameACKDATE2



Text Data
nameACKNOTES2
width300px
contenttext
 


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
nameACK3


AYes



BNo





Text Data
nameACKNAME3
typeline
contenttext
 



Date Data
formatdd-MMM-yyyy
nameACKDATE3
 



 
Text Data
nameACKNOTES3
width300px
contenttext


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


List Data
nameACK4


AYes



BNo





 
Text Data
nameACKNAME4
typeline
contenttext



Date Data
formatdd-MMM-yyyy
nameACKDATE4
 



 
Text Data
nameACKNOTES4
width300px
contenttext




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


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bgColorlightyellow
titleColormaroon
titleBGColorlightcyan
titleProgram Administration: STAFF USE ONLY

Approved Travel Elements:

Table Data
nameTRAVELAPPROVAL
initialRows1


TravelerApproved
Arrival Date
Approved
Departure Date
Approved Fees 


ATRAVELERlinetextBLOCK




dd-MMM-yyyyADEPARTBLOCK



dd-MMM-yyyyARETURNBLOCK



trueFUNDEDchecknewlineINLINE


AAirfare



BHotel/Lodging



CPer Diem



DVisa



ERegistration





Staff Department Notifications:

Table Data
nameREQUIREMENTS
initialRows1


Program RequirementDate Satisfied/ConfirmedStaff NameNotes


RQMTBLOCK


AProgram Criteria Satisfied 


BConstituency Travel Notified



CTravel Booking Initiated with Attendees 


DTravel Booking Completed/Confirmed 


EOther Disposition 




dd-MMM-yyyySATISFIEDBLOCK



STAFFNAMElinetextBLOCK




NOTES300pxtextBLOCK





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