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Info

Please use the <Edit Contents> menu option (directly above) to complete this form. Remember to <Save> the page (bottom right) after making updates. Other than the two required fields immediately below, you may complete any portion of this form, save, and return later to continue where you left off.

Note

Trip Proposals must be completed at least six (6) weeks before the event start date.

Person Completing Form
Name:
Text Data
namePERSON
typeline
contenttext
requiredtrue

 

Date:

Date Data
formatdd-MMM-yyyy
nameAPPDATE
requiredtrue
now

Column
width45%
Panel
bgColorwhite
titleColormaroon
titleBGColorlightcyan
titleSTAFF USE ONLY
Application
Status 
Assessment
Due-Date 
Form ID #
Text Data
nameSTATUS
typeline

 

Report Info
data:END > shift + 22d
data:END > shift + 22d
formatdd-MMM-yyyy

Status
colourBlue
titleAF04

Trip Proposal Section

LINK: AFRALO Trip/Event Assessment 4 DRAFT

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

Number Data
minValue1
maxValue5
format###
nameTRIPS
width100px
 

2) Traveler Contact Information and Itinerary:

Table Data
nameCONTACTINFO
initialRows1
TravelerEmailFrom
City
From
Country
Depart
Date
Return
Date
TRAVELER1linetextBLOCK

 

T-EMAILlineBLOCK

 

FROM1linetextBLOCK

 

FROM2linetextBLOCK

 

dd-MMM-yyyyDEPARTBLOCKdd-MMM-yyyyRETURNBLOCK
3) Special Travel Circumstances, Arrangements,
Explanations, or Notations: 
(Please identify each traveler, as applicable)
Text Data
nameSPECIAL
width650px
contenttext

 

4) Event/Conference Name, Title, or Descriptor:
Text Data
nameEVENT
contenttext

 

5) Event/Conference Dates:
Start:
Date Data
formatdd-MMM-yyyy
nameSTART
 
End:
Date Data
formatdd-MMM-yyyy
nameEND
 
6) Event/Conference Website Link:
Text Data
nameLINK

 

7) Primary Event/Conference Location:
Street
Address:
Text Data
nameADDRESS
contenttext

 

City:
Text Data
nameCITY
typeline
contenttext

 

Country:
Text Data
nameCOUNTRY
typeline
contenttext

 

8) ICANN Geographic Region:
List Data
nameREGION
AAfrica

 

BAsia

 

CAustralasia/Pacific Islands

 

DEurope

 

ELatin America and Caribbean

 

FMiddle East

 

GNorth America

 

HRussia/CIS/Eastern Europe

 

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


Text Data
nameSPONSORS

 

10) Proposed Goals and Outcomes:

Text Data
nameGOALS
contenttext

 

11) Additional Information (optional):

Text Data
nameADDTLINFO
 

======================================= 
Panel
titleColornavy
titleBGColorlightyellow
titleCommunity Confirmation Section

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

AcknowledgementsConfirmed?NameDateNotes
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
nameACK-1
AYes

 

BNo

 

Text Data
nameACKNAME-1
typeline
contenttext

 

Date Data
formatdd-MMM-yyyy
nameACKDATE-1
 
Text Data
nameACKNOTES-1
width300px
contenttext

 

The ICANN Organization / Structure's leadership has authorized the submission of this Trip Proposal.
List Data
nameACK-2
AYes

 

BNo

 

Text Data
nameACKNAME-2
typeline
contenttext

 

Date Data
formatdd-MMM-yyyy
nameACKDATE-2
 
Text Data
nameACKNOTES-2
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
nameACK-3
AYes

 

BNo

 

Text Data
nameACKNAME-3
typeline
contenttext
 
Date Data
formatdd-MMM-yyyy
nameACKDATE-3
 
Text Data
nameACKNOTES-3
width300px
contenttext
 
  =======================================================

 

 

Panel
bgColorlightyellow
titleColormaroon
titleBGColorlightcyan
titleProgram Administration: STAFF USE ONLY

Approved Travel Elements:

Table Data
nameTRAVELAPPROVAL
initialRows1
TravelerApproved
Arrival Date
Approved
Departure Date
Approved Fees 
ATRAVELERlinetextBLOCK

 

01-Jul-2015dd-MMM-yyyyADEPART30-Jun-2016BLOCK01-Jul-2015dd-MMM-yyyyARETURN30-Jun-2016BLOCK

trueFUNDEDchecknewlineINLINEAAirfare

 

BHotel/Lodging

 

CPer Diem

 

DVisa

 

ERegistration

 

Staff Department Notifications:

Table Data
nameREQUIREMENTS
initialRows1
Program RequirementDate Satisfied/ConfirmedInitialsNotes
RQMTBLOCKASpeakers Bureau

 

BCommunications Department

 

CMeetings Team

 

DConstituency Travel Notified

 

ETravel Booking Initiated with Attendees FTravel Booking Completed/Confirmed GProgram Criteria Satisfied 
dd-MMM-yyyySATISFIEDBLOCKINITIALS50pxBLOCKAJDL

 

BRH

 

CBR

 

EJDJ

 

FKB

 

NOTES300pxtextBLOCK

 

Trip Proposal Confirmed and
Transferred

Program Admin Transfers from Community Drafts to Approved Forms:

Trip Proposal 
Date Data
formatdd-MMM-yyyy
nameP-POSTED
 
Trip/Event Assessment Confirmed andTransferred to Approved Forms: 
Date Data
formatdd-MMM-yyyy
nameA-POSTED
 

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