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.
| Application Status | Assessment Due-Date | Assessment Status |
Trip Proposal Section | |||||||||||||
1) Number of Travelers: | |||||||||||||
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| 2) Application Date: | |||||||||||||
3) Dates of Requested Travel: |
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4) Travel Itinerary: |
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| 5) Event/Conference Name, Title, or Descriptor: | |||||||||||||
| 5a) Event/Conference Website Link: | |||||||||||||
| 6) Primary Event/Conference Location: | |||||||||||||
| 7) ICANN Geographic Region: | |||||||||||||
8) Activity Sponsors: | |||||||||||||
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:
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| 3) Date Completed: | |||||||||||||
| 4) Additional information pertaining to this outreach event (optional): | |||||||||||||
| ============================================= | |||||||||||||
| Program Requirement | Date Satisfied | Initials | Notes |
| Program Administrator | Confirmed? | Date | Rationale |
|---|---|---|---|
CROPP Application Template v5 (Sep 2013)
