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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. Note: Each participant must complete a separate Trip Proposal Form even if multiple individuals will be attending the same event.

STAFF USE ONLY
Application
Status 		Assessment
Due-Date 		Assessment
Status 

Trip Proposal Section

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

TravelerEmailAlternateEmail
2) Application Date:

3) Dates of Requested Travel:

Departure:
Return:

4) Travel Itinerary:

From City:Country:
To City:Country:
Other:
(Describe)
5) Event/Conference Name, Title, or Descriptor:
5a) Event/Conference Website Link:
6) Primary Event/Conference Location:
7) ICANN Geographic Region:

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


9) Purpose and Goals:

10) Proposed Outcomes:
11) Additional Information (optional):

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.

The ICANN Organization/Structure's leadership has authorized the submission of this Trip Proposal.
The ICANN Stakeholder Engagement Vice-President has concurred that the Purpose/Goals of this Trip Proposal are consistent with operational plans and/or strategies.

Trip Assessment Section

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

2) Describe how the original Outcomes were achieved:

 

3) Date Completed:
4) Additional information pertaining to this outreach event (optional):
 =============================================
Program Administration: STAFF USE ONLY
Program RequirementDate SatisfiedInitialsNotes
Confirmation Section: STAFF USE ONLY
Program AdministratorConfirmed?DateRationale

CROPP Application Template v5 (Sep 2013)

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