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This is a sample EoI Form for viewing only. <Edit Contents> button is disabled. If you plan to fill out an EoI, please contact At-Large Staff.


Instructions: If you are new to this EoI Form, please click in this box to review IMPORTANT INFORMATION to assist you in completing this Form



This EoI Form contains Profile Sections (A-C) and a separate Application Section (D) for this At-Large Board Member Selection cycle.

Please use the <Edit Contents> menu option (above) to complete all form sections and always remember to <Save> your page (see the button at the bottom right) (Note: We recommend that you NOT click the <Save Draft> button because its operation is not intuitive, you may lose your work). If you are unable to complete the entire form in one session, you may return multiple times to complete it using <Edit Contents> and <Save> when finished.

To indicate to the Program Admin Staff that you are finished working with the EoI Form, please complete the "Consent and Authorization" area at the bottom and click <Save>. As soon as realistically possible, Program Admin Staff will validate your final submission for completeness and subsequently restrict it from further editing

The right column contains data fields which are either free-form text, drop-down selection menus, or numeric. For certain text fields, clicking your mouse in the cell will bring up an Editor offering an extensive menu at the top containing formatting options including: headings, fonts, bullets, paragraph indentation, links, tables, and an insert menu offering even more capabilities (e.g., images, attachments).

As a precautionary measure, there are very few embedded links in this EoI Form to prevent being transported out and potentially losing your work. External materials that can be referenced are marked in orange bold text. If you need to consult any of these documents, be sure to <Save> your active page (see the button at the bottom right of this Form) and return to it when convenient. If you are comfortable working in multiple tabs/windows and want to visit any external source while working in this document, be sure to <Right-Click> the link using your mouse (or pointing device) to open it in another tab/window. For your convenience, all documents and materials referenced in this year's application process are contained on these pages: 

If you have any questions about this process, please send an email to the At-Large Staff.

IMPORTANT:

  • DO NOT change the Page Title (top left) under any circumstances.
  • This EoI Form must be completed in English. Please set your browser in the English language setting in order to avoid auto-translation of the EoI Form by your browser to other languages.
  • All EoI forms will be closed to further editing effective 23:59 UTC on Friday, 1 November 2019




IMPORTANT:

  • Please use the <Edit Contents> menu option (above) to complete all form sections and always remember to <Save> your page. You may resume your progress and return multiple times to complete the EoI Form using <Edit Contents> and <Save> when finished.
  • When you have finished entering ALL of the applicable information for this EoI Form and are prepared to release it to the BCEC, please complete the Consent & Authorization immediately below Section D.




Section A: Identification, Contact Information, Resume, and Professional References

1) Name:


First or GivenSurname or Family






Picture/Image (Optional):

Explanation

In order to provide Candidates with as many options to promote their qualifications as are feasible, the BCEC is inviting each Candidate to submit a photograph in the form of an uploaded picture/image.

IMPORTANT: If you choose not to take advantage of this option, there will be no detrimental effect upon your candidacy.

To provide a picture, please read the instructions below.

 Instructions


Click in the field to the right to open up the text input window. Then click the <"+" Insert more content> menu button, select <Image>, then choose (or browse) to locate an image file (e.g., JPG, PNG, BMP) from your local computer to upload. After insertion, please click on the picture and adjust the size to no larger than 200 pixels.



In the column to the right, please provide your Referee's name, e-mail address, telephone number, professional position, and a brief description of your relationship with them. 

Use the "Add Row" to add additional rows to the table; the "x" can be used to delete rows added by mistake.



Name

Email

TelephoneRelationshipYears Known













Section B: Qualifications & Professional Background

Purpose of This Section

The purpose of Section B is to help the Committee understand the skills and experience you would bring to ICANN, how you would help ICANN achieve its mission, and how you meet the criteria for the leadership position the BCEC will fill. Please refer to the At-Large Board Member Candidate Requirements - 2017 page for a description of the criteria. The BCEC needs to understand why you are the right person for the position to which you are applying. Please be bold in telling the Committee about yourself and your ideas.


1) Please describe any current and past volunteer positions, roles, and accomplishments. The Committee is particularly interested in Board or similar directorship experience. Please include the name and web page of such organizations, if applicable.



2a) Have you held or do you currently hold a Board or executive management position in any organization? 






2b) If "Yes," please state the nature and size of the organization(s) in which you currently hold or have held a Board or executive management position.



3a) Do you have experience working with non-profit organizations?






3b) If "Yes," please state the nature and size of any non-profit organization(s) including any Board positions or executive committees upon which you currently serve or have served.



4) Briefly describe any experience you have had working with groups in various locations and time zones around the globe.



5) Being able to read and to express yourself publicly in English is mandatory for leadership positions at ICANN.  Do you meet this criterion?






6) Which other languages do you speak and at what level of fluency?

Instructions

Use the "+ Add Row" to add additional rows to the table; the "x" can be used to delete rows added by mistake.




LanguageLevel of FluencyNumber of Years















Section C: Internet & ICANN Involvement

1) Describe your current and past involvement in, contributions to, and leadership roles in activities and organizations involved in the development and operation of the Internet, its naming and addressing infrastructure, and/or its security and stability. 

Explanation

Please describe any involvement with the operation of ccTLD, gTLD registries or registrars, IP address registries, or relevant DNS technical or policy development process, including Internet technical protocols and standards. Your answer should include details of any involvement with ICANN's policy development processes, including its creation and evolution; Supporting Organizations; Councils; and/or Advisory Committees.




2) Conflicts of Interest

Instructions

Please indicate clearly if you have any areas of actual or potential conflicts with ICANN. Please refer to the ICANN Conflicts of Interest Policy which specifically addresses conflicts for ICANN Directors, Officers and key employees. If you have had any relationship with an ICANN accredited registry or registrar (other than registering a domain name) or any organization that has been in dispute with ICANN, please describe that relationship here. Conflicts of interest are not necessarily disqualifying, since we anticipate that many experienced people may have such relationships. The At-Large Community selected Board Member should be independent from ICANN Stakeholders whose financial situation is significantly affected by ICANN decisions.




3) Please explain any positions you hold as Director, major shareholder, or employee of a Generic Top Level Domain (gTLD) Registrar or Registry, Country Code Top Level Domain (ccTLD) Registry or a Regional Internet Registry (RIR).



Section D: Application for At-Large Board Member Position

1) Please state your opinion about what would be your unique expertise or perspective and what added value you might contribute to the ICANN Board:



2) Please describe how and why you meet the criteria for this position:

Instructions

See At-Large Board Member Candidate Requirements - 2017 document for eligibility criteria and other selection factors. Describe how your work and other experience helps you meet the criteria for the position you are applying for. You may wish to describe how your previous experience is relevant to your candidacy.




3) Please state what you would contribute in the At-Large selected ICANN Board Member Position to the At-Large Community



4) Please describe specifically how and why you will be able to advance, at the ICANN Board, the interests of the At-Large Community and the broader global community of Internet end-users.



5) Time Commitment:

Explanation

The basic responsibilities of an ICANN Director require a minimum commitment of time which when averaged out over the year is roughly equivalent to 20-24 hours each week. This includes participation in three ICANN meetings/year, two Board retreats/year and work on Board Committees. The time spent in these basic responsibilities is typically clustered around Board meetings and monthly teleconferences, but there is a constant flow of information requiring attention on a near daily basis.

Directors are expected to attend three ICANN meetings per year and depending on the location and including travel time and preparation this could be a commitment of about ten (10) days per meeting. In addition the board occasionally holds shorter face-to-face meetings such as retreats.

Directors spend additional time in connection with their work on Board Committees, a commitment that varies in relation to the number of Committees on which they serve, the scope of the Committee's responsibilities, and their role as Chair or Member of the Committee.

Are you able to commit this amount of time for this position?






6) Please describe your understanding of changes to ICANN's Bylaws, organizational structure, and accountability mechanisms that have been put in place as part of the transition of the stewardship of IANA functions. Please also describe any personal involvement you have had in these changes.




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


Consent and Authorization:

Please click here to complete the Consent and Authorization section of this EoI Form



The statements below seek your consent and authorization for actions that may be taken by the At-Large Board Candidate Evaluation Committee (BCEC) in its consideration of your Expression of Interest (EoI).

You acknowledge and/or authorize that:

  • This EoI will be made available to the BCEC and ICANN staff supporting the BCEC. All copies will be deleted once the entire selection process is complete.
  • Before the final slate of Candidates has been announced, your completed EoI Form will be treated as confidential, but may be shared on a confidential basis with your Referees or with selected independent sources should the BCEC consider third party checks advisable.
  • After the BCEC selection process is complete:
    • For those Applicants who are selected, the BCEC will make publicly available Section A 1, 2, photo, 5,6,7, Sections B, C and D in full.
    • For those Applicants who are not selected but wish to allow Regional At-Large Organizations (RALOs) to consider petitioning to add their them to the slate, the BCEC will similarly make publicly available their EoIs
    • For those Applicants not selected and who do not wish to be considered by the RALOs), their EoI will continue to be treated as confidential.
    • The above publication processes are in accordance with the ALAC Rules of Procedure 19.4.5 and 19.9.
  • Your Referees will be given no less than 21 calendar days in which to submit their references.
  • Your references will not be shared with any persons other than the BCEC and its ICANN support staff.
  • The BCEC may consult with your Referees, investigate other information publicly available about you, and conduct additional independent reference checks. You will not be entitled to review or access any of the information received, obtained, generated, or considered by the BCEC regarding your EoI Form or any of the BCEC’s discussions or deliberations regarding you or any other Applicant.
  • Although the BCEC will take reasonable steps to ensure that its confidentiality procedures are followed, Applicants shall have no claims against ICANN, the BCEC, ICANN support staff or affiliated persons in the event that information is disclosed despite these procedures.
  • Following any Applicant being placed on the election slate, either by the BCEC or through the RALO petition process, their EoI will be provided to an external agency which will perform a background check. In the unlikely event that a sufficiently serious issue is uncovered, the Applicant will be required to withdraw.

The information supplied by you herein is complete, accurate, and provided in good faith. Your EoI Form will be closed to further editing effective at 23:59 UTC on Friday, 1 November 2019.[1] If your EoI Form has not been submitted or if your submitted EoI Form is found to be incomplete at that time, it will not be considered by the BCEC.

Following the BCEC publication of its selected slate, the five RALOs will have an opportunity to petition to add to the slate applicants that have not been selected by the BCEC.

Select one of the following:

  •  If I am not selected by the BCEC, I allow my EoI to be published to allow consideration by the RALO petition process.
  •  If I am not selected by the BCEC, keep my EoI confidential.

When you have finished completing all of the applicable information contained in this EoI Form (Sections A to D), please indicate your understanding of, and agreement to, this Consent and Authorization and that you seek to become a Candidate under the conditions described above.

Please select "Yes - Agree and Submit", complete the date field below, and click <Save> (see the button at the bottom right) to signify that:

  1. The At-Large Staff may perform a completeness validation;
  2. This EoI Form may be closed to further editing; and
  3. BCEC members may begin reviewing it.

(Note: All forms will be closed to further editing effective 23:59 UTC on Friday, 1 November 2019).[2]


[1] 30 days from call for EoI.

[2] 30 days from call for EoI.


I understand and agree to the above
provisions and submit my completed
EoI Form for consideration by BCEC:






Date:








Profile StatusApplication StatusRegion Designation















Program RequirementDate SatisfiedInitialsNotes






















At-Large Board Candidate Application Template v2 (Oct 2019)