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 # |
APPROVED | 02-Jul-2016 | AF04 |
Trip Proposal Section | |||||||||||||
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1) Number of Travelers: | 1 | ||||||||||||
2) Traveler Contact Information and Itinerary:
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3) Special Travel Circumstances, Arrangements, Explanations, or Notations: (Please identify each traveler, as applicable) | I will pay the remaining nights cost from my own pocket. As of 29 April, 1 additional night and 2 additional per diems have been approved for CROPP support. | ||||||||||||
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: | Africa | ||||||||||||
9) Activity Sponsors: | AFRINIC, AfNOG, AfTLD, AfREN, AfPIF, AfIGF, AfricaCERT and ISOC | ||||||||||||
10) Proposed Goals and Outcomes: | I will be making a presentation and AFRALO will have a booth in this event free of charge for outreach material that will be provided by our At-Large staff This will enhance the ICANN credibility by showing that the ICANN community participate actively by providing substantial and valuable contribution. It also give it more visibility. On the other hand this is a strong effort of outreach in a country where AFRALO has no ALS | ||||||||||||
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. | Yes | Daniel K. Nanghaka | 09-Mar-2016 | |
The ICANN Organization / Structure's leadership has authorized the submission of this Trip Proposal. | Yes | Aziz HILALI | 15-Mar-2016 | |
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. | Yes | Pierre Dandjinou | 24-Mar-2016 | |
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Approved Travel Elements:
Traveler | Approved Arrival Date | Approved Departure Date | Approved Fees |
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Tijani Ben Jamma | 05-Jun-2016 | 11-Jun-2016 | Airfare |
Staff Department Notifications:
Program Requirement | Date Satisfied/Confirmed | Initials | Notes |
Constituency Travel Notified | 10-Apr-2016 | JDL | Tijani will pay for nights outside of the approved CROPP 3 nights himself; can use June 5 - 7 as CROPP nights. As of 29 April, addt'l night and 2 addt'l per diems approved for this trip. In conjunction with Proposal 5 - these addt'l coverages take the place of a 5th AFRALO trip. For CROPP reporting purposes, Trip Proposal 5 is being shown as 2 travelers. |
Program Admin Transfers from Community Drafts to Approved Forms: | |||
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Trip Proposal | 14-Apr-2016 | Trip/Event Assessment |
CROPP Trip Proposal Template v4 (Aug 2015)