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Instructions:

  1. Please use the <Edit Contents> menu option (directly above) to complete this form. Remember to <Save> the page (bottom right) after making updates.
  2. Multiple travelers are asked to collaborate as a team in pulling together the appropriate information.
  3. Some information fields are 'richtext' so that they can accommodate tables, links, images, attachments, and other formatting capabilities that may be useful in explaining/describing this proposal.
  4. This form may be edited/saved as many times as needed. When completed, please notify your Program Coordinator (PC) for further processing.


Trip Proposals must be approved within the Organization/Structure and Regional GSE Team at least six (6) weeks before the event start date.
Questions about this program should be directed to: CROP Staff.


Person Completing Form
Name:


 


Date:


now






Application
Status 		Assessment
Due-Date 


 






Trip Proposal Section

LINK TO TRIP ASSESSMENT : NCUC Trip Assessment 4 DRAFT

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


 


2) Traveler Contact Information and Itinerary:


TravelerEmailFrom
City		From
Country		Depart
Date		Return
Date


 



 



 



 



 



 




3) Special Travel Circumstances, Arrangements,
Explanations, or Notations: 
(Please identify each traveler, as applicable)


 


4) Event/Conference Name, Title, or Descriptor:


 


5) Event/Conference Dates:


Start:


 


End:


 



6) Event/Conference Website Link:


 


7) Primary Event/Conference Location:


Street
Address:


 


City:


 


Country:


 



8) Indicate whether it is a regional trip OR an out-of-region trip.




 


 



9) ICANN Global Stakeholder Engagement Region:



 


 


 


 


 


 


 


 



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



 


11) Proposed Goals and Outcomes:

Content Guidelines (click here)


Please develop specific goals/outcomes for as many of the following categories as applicable:

1) Workshops/Seminars/Presentations including roles (e.g., speaker, facilitator, organizer), relevant content, literature to be disseminated, and specific purposes/objectives.

2) Engagement/Outreach including broadening awareness of ICANN in targeted regional areas (e.g., under-represented).

3) Recruitment including formal/informal invitations to become involved in ICANN stakeholder communities, working groups, and/or fellowship programs.

4) Fulfillment of documented Outreach Strategic Plans and/or ICANN Regional Strategies.

5) Knowledge Sharing including intentions to extend learnings within and among ICANN stakeholder communities.


 


 


12) Additional Information (optional):


 


_______________________________________________________________ 


Note: The first three elements below should be completed by a Program Coordinator (PC) designated by this organization/structure.

AcknowledgementsConfirmed?NameDateNotes
The participants identified in this application agree to abide by the terms and conditions of this FY17 Community Regional Outreach Program (CROP) as outlined on the CROP Procedures & Guidelines 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.



 


 




 



 



 


The CROP Staff Administrators confirm that this trip satisfies the program's terms, guidelines, and policies.



 


 




 



 



 


  =======================================================



Approved Travel Elements:


TravelerApproved
Arrival Date		Approved
Departure Date		Approved Fees 


 



 



 




 


 


 


 


 




Staff Department Notifications:


Program RequirementDate Satisfied/ConfirmedInitialsNotes



 


 


 


 


 


 


 


 




 




 


 


 


 


 


 




 




Program Admin Transfers from Community Drafts to Approved Forms:

Trip Proposal


 


Trip Assessment


 




CROP Trip Proposal Template (May 2017)