Complete one application for each activity taught. (The same program with two locations would need two applications.) Copy this form as needed.

Teaching is awarded as an incentive for attorneys to enhance or benefit the legal profession by teaching other attorneys; therefore teaching must be in association with an approved CLE program. Teaching directed to a non-attorney audience, while resulting in self-improvement as a form of self-study, does not qualify for teaching credit.

This form should include both teaching time and attendance for the same program.

Preparation of written materials for an accredited program but not teaching the program will not qualify for either teaching or authorship credit.


PART A ATTORNEY INFORMATION
1. Attorney: ______________________________ Supreme Court Number__________________
2. Address: _______________________________ Day Phone #_________________________
    City State Zip _______________________________________


PART B ACCREDITED PROGRAM INFORMATION
3. CLE Activity Sponsor:________________________________________________________
4. Title of CLE Activity: _________________________________________________________
5. Title of Presentation Segment: _________________________________________________
6. Date and Location of Presentation: _____________________________________________
7. How many CLE hours was this program approved for?______________________________

PART C PRESENTATION AND ATTENDANCE INFORMATION
8. Number of minutes of actual presentation: CLE _______ incl.  Prof. Responsibility _______
9. Number of minutes spent in preparation for teaching this course: _____________________
10. Additional hours spent attending (Time not spent teaching):    CLE _____ incl.  Prof. Responsibility _______


Based on this information, the Commission will issue an affidavit that you must sign and return.

Signature _______________________________ Date: ________________________________