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Section
Column
Info

Please use the <Edit Contents> menu option (directly above) to complete this form. Note that most of the fields in the right column are REQUIRED ; therefore, you will not be able to SAVE the page until they are completed.

Column
Panel
bgColorwhite
titleColormaroon
titleBGColorlightcyan
titleSTAFF USE ONLY

Application
Status 
Assessment
Due-Date 
Assessment
Status 
Text Data
nameSTAT1
typeline

 

date

report-info
data

nameDUE
:RETURN > shift + 22d
data:RETURN > shift + 22d
formatdd-MMM-yyyy

 
Text Data
nameSTAT2
typeline

 

Trip Proposal Section

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

Number Data
minValue1
maxValue5
nameTRIPS
format###
requiredtrue
 
Table Data
nameTRAVELERS
initialRows1
TravelerEmail (Redacted) AlternateEmail (Redacted)
TRAVELER BLOCK line true

 

gsecmntyrgnloutrchprgm:admin BLOCK T-EMAIL BLOCK line true

 

ALTERNATE BLOCK line

 

gsecmntyrgnloutrchprgm:admin BLOCK A-EMAIL BLOCK line

 

2) Application Date:

Date Data
nameAPPDATE
formatdd-MMM-yyyy
today

3) Dates of Requested Travel:

Departure:
Date Data
nameDEPART
formatdd-MMM-yyyy
requiredtrue
 
Return:
Date Data
nameRETURN
formatdd-MMM-yyyy
requiredtrue
 

4) Travel Itinerary:

From City:
Text Data
nameFROM1
typeline

 

Country:
Text Data
nameFROM2
typeline

 

To City:
Text Data
nameTO1
typeline

 

Country:
Text Data
nameTO2
typeline

 

Other:
(Describe)
Text Data
nameOTHER

 

5) Event/Conference Name, Title, or Descriptor:
Text Data
nameEVENT
requiredtrue

 

5a) Event/Conference Website Link:
Text Data
nameLINK

 

6) Primary Event/Conference Location:
Text Data
nameLOCATION
requiredtrue

 

7) ICANN Geographic Region:
List Data
nameREGION
Africa A

 

Asia B

 

Australasia/Pacific Islands C

 

Europe D

 

Latin America and Caribbean E

 

Middle East F

 

North America G

 

Russia/CIS/Eastern Europe H

 

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


Text Data
nameSPONSORS
requiredtrue

 

9) Purpose and Goals:

Text Data
namePURPOSE
requiredtrue
 

10) Proposed Outcomes:
Text Data
nameOUTCOMES
requiredtrue

 

11) Additional Information (optional):

Text Data
nameINFO-PROPOSAL
 

ACKNOWLEDGEMENTS (Required):

The participants identified in this application are familiar with the Program Operations associated with this Community Regional Outreach Pilot Program (FY14) and agree to abide by its terms and conditions.

List Data
nameT&C
requiredtrue
Yes A

 

No B

 

The ICANN Organization/Structure's leadership has authorized the submission of this Trip Proposal.
List Data
nameAUTH
requiredtrue
Yes A

 

No B

 

The ICANN Stakeholder Engagement Vice-President has concurred that the Purpose/Goals of this Trip Proposal are consistent with operational plans and/or strategies.
List Data
nameRVP
requiredtrue
Yes A

 

No B

 

Trip Assessment Section

1) Describe how the original Purpose and Goals were accomplished:

Text Data
namePURPOSE2
 

2) Describe how the original Outcomes were achieved:

 

Text Data
nameOUTCOMES2

 

3) Date Completed:
Date Data
nameCOMPLETED
formatdd-MMM-yyyy
 
4) Additional information pertaining to this outreach event (optional):
Text Data
nameINFO-EVAL

 

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