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.
Trip Proposals must be completed at least six (6) weeks before the event start date.
Person Completing Form | |||
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Name: | Mohamed Tijani BEN JEMAA | Date: | 08-Mar-2016 |
Application Status | Assessment Due-Date | Form ID # |
| AF04 |
Trip Proposal Section | |||||||||||||
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1) Number of Travelers: | |||||||||||||
2) Traveler Contact Information and Itinerary:
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3) Special Travel Circumstances, Arrangements, Explanations, or Notations: (Please identify each traveler, as applicable) | The events lasts for 12 nights, means that to attend it as a whole, we need to spend 14 nights. I will attend the Policy discussion only which will be from 6 to 10 June, so I will leave my country on 5 and leave the summit venue on 11 June which is a 6 nights travel. And since the CROPP program doesn't cover this period for a slot, I request to merge 2 slots for this trip | ||||||||||||
4) Event/Conference Name, Title, or Descriptor: | 2016 Africa Internet Summit (AIS'16) | ||||||||||||
5) Event/Conference Dates: |
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6) Event/Conference Website Link: | https://internetsummitafrica.org/ | ||||||||||||
7) Primary Event/Conference Location: |
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8) ICANN Geographic Region: | |||||||||||||
9) Activity Sponsors: | AFRINIC, AfNOG, AfTLD, AfREN, AfPIF, AfIGF, AfricaCERT and ISOC | ||||||||||||
10) Proposed Goals and Outcomes: | |||||||||||||
11) Additional Information (optional): | |||||||||||||
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Note: To be completed by a Pilot Program Coordinator (PPC) designated by this organization/structure.
Acknowledgements | Confirmed? | Name | Date | Notes |
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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. | ||||
The ICANN Organization / Structure's leadership has authorized the submission of this Trip Proposal. | ||||
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. | ||||
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Approved Travel Elements:
Traveler | Approved Arrival Date | Approved Departure Date | Approved Fees |
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Staff Department Notifications:
Program Requirement | Date Satisfied/Confirmed | Initials | Notes |
Trip Proposal Confirmed and Transferred to Approved Forms: | Trip/Event Assessment Confirmed and Transferred to Approved Forms: |
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CROPP Trip Proposal Template v4 (Aug 2015)