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
Name: Date:

STAFF USE ONLY
Application
Status 		Assessment
Due-Date 		Form ID #

NCUC05

Trip Proposal Section

LINK: FY16 NCUC Trip/Event Assessment 5

1) Number of Travelers:
(Note: Each traveler uses one trip of the five (5) 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) ICANN Geographic Region:

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


10) Proposed Goals and Outcomes:

11) Additional Information (optional):

======================================= 
Community Confirmation Section

Note: To be completed by a Pilot Program Coordinator (PPC) designated by this organization/structure.

AcknowledgementsConfirmed?NameDateNotes
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.
  =======================================================
Program Administration: STAFF USE ONLY

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/Event Assessment


CROPP Trip Proposal Template v4 (Aug 2015)