ATTORNEY APPLICATION FOR CLE COURSE APPROVAL …

1 Virginia mcle Board Virginia State Bar 1111 East Main Street, Suite 700 Richmond, VA 23219-0026 804-775-0577 APPLICATION FOR CLE COURSE APPROVAL (FORM 4) mcle COURSE Completion Deadline October 31 / mcle Reporting Deadline December 15 Please allow 90 days for board decisions on all applications needed for compliance. Fax or email submissions not accepted. : VSB ID Number_____Name: _____Daytime Phone: _____Email Address: _____Course Sponsor_____ Sponsor Representative_____ Phone: _____ Email address:_____ of CLE hours:_____including (_____)Ethics Type. Check all that apply to your participation at this COURSE :Live ___ Speaker in Room ____ Videoconference* ___Telephone* ____Webcast* Pre-recorded ___ Audio* ____Video* ___CD-ROM* ___Online ___Other_____ Setting ____ Group Setting ____*Delivered to Individuals ___In-House Attendance: ___OPEN ____ CLOSED *For all distance learning you must submit sponsor-issued certificate of attendance.

2 * COURSE sponsor must complete Opinion 16 on page (s) :_____(see 90-day late fee below)Location (city/state) Registration Fee $_____ Target Audience: ____ Attorneys ____ ATTACHMENTS: Omission of any attachments or information will delay the processing and review ofthis CLE APPLICATION . COURSE materials must be arranged in order and labeled if sessions are not apparent. COURSE Agenda (times are required to compute CLE credit hours). Materials from each session attended (5-7 pages each) CD, flash drive or electronic link are acceptable. Certificate of attendance: *For distance learning (webcast, telephone, videoconference, online, video, audio) Sessions attended: Mark which sessions were attended. Only sessions with written materials are are distributed: Before program_____ at program_____ to practice: If program does not cover a recognized legal topic, attach statement of how this courserelates to your Fee (requi red for al l appl icati ons)$25 or $50 (if received or remain incomplete 90 days past the program date) Total Enclosed: Make check payable to Treasurer of Virginia.

3 $_____Check#_____ Certification:I certify that I attended _____CLE hours, including (_____) Ethics hours of the above-names (VSB Member Applicant) _____ A materially false statement shall be subject to appropriate disciplinary action. mcle BOARD USE ONLY Cours e I D#_____ De ci sion_____ CLE Hours_____ Re a son Code_____ Ethi cs Hours_____ Te a ching Cre dit_____ Page 2 mcle Opinion 16 Compliance Information This information must be completed by COURSE provider for all distance learning courses and be included with your APPLICATION packet. 1. The COURSE must afford interaction between attendees and the presenter or other subject matter expert with respect to the subject matter of the COURSE . Please describe how interaction is achieved for you program. _____ _____ _____ 2. The provider must have a system which allows certification of attendance to be controlled by the provider which permits the provider to verify the date and time of attendance.

4 How do you accomplish this? _____ _____ _____ 3. Do you provide information on the original recording date?_____ 4. Is the program provided in audio or audiovisual format?_____ Text based?_____ 5. Do you provide written instructional materials to cover the subject matter of the program? _____ How and when are the materials provided? _____ _____ 6. You must provide the ATTORNEY with a certification of attendance once you have verified actual time in attendance. _____ COURSE Provider _____ Contact Name _____ Signature Page 3 Attendance at pre-recorded programs is limited to hours per compliance year. Pre-recorded programs that include an appropriate simultaneous, live interactive component may be considered for live interactive APPROVAL and not be subject to the hours limitation. Request for Special Live Interactive APPROVAL of a Pre-recorded Program (See Opinion 16) Please respond to the following questions and provide attachments: 1.

5 Will this recorded program be held in a group setting? _____ If so, estimated number in attendance_____ 2. How will simultaneous, live interaction be achieved? _____ _____ _____ 3. Will the live interaction be with the original presenter? _____ If not, please provide name(s) and attach the resume/credentials for the discussion facilitator or panel members. _____ 4. Attach agenda showing times devoted to recorded presentation and live interaction. DEFINITION OF COURSE TYPES AND EXPLANATION OF VIRGINIA CRITERIA FOR APPROVAL OPEN - Cours e a dvertised a nd open to all a ttorneys CLOSED - Cours e open only to l aw firm, in-house law department, gove rnment a gency or me mbers of a professional organization. LIVE - I ns tructor a nd attendees participate simultaneously IN-HOUSE - Progra m offered to attorneys within a firm, corporation or gove rnment agency. GROUP SETTING - Progra m offered i n group of 2 or more a ttorneys.

6 (Where individual a ttendees are conferenced i nto a program the sponsor mus t me et Opinion 16 s tandards) TELECONFERENCE, SATELLITE, VIDEOCONFERENCE, OR LIVE WEBCAST- To me e t Virginia re gulations the COURSE must (1) ha ve a means to connect audience with fa culty a nd/or other attendees to allow for l ive i nteraction a nd discussion.(2) wri tte n materials must be a vailable to participants prior to the broadcast.(3) ha ve a ttendance tracking - See OPI NION 16 VIDEO, AUDIO, CD-ROM - To me e t Virginia re gulations the COURSE must (1) ha ve a bility to i nteract with the presenter or other s ubject matter e xpert. (Email contact i nformation is s ufficient)(1) ha ve a t l east 2 a ttorney participants or be proctore d (not restricte d to only VA a ttorneys)(2) be conducted in an e ducational s etting(3) ha ve wri tten materials provided to each participant prior to the , CD-ROM ON-DEMAND programming (SELF STUDY NOT APPROVABLE) - To me e t Vi rginia regulations the COURSE must (1) be i n a udio or audio/vi deo format.

7 Te xt based courses are not approvable(2) a l low the participant to i nteract with the presenter and/or other a ttendees(3) ha ve wri tten materials a vailable to participants for re fere nce during a nd s ubsequent to program(4) ha ve a ttendance tracking - See OPI NION 16 For a dditional information see mcle Re gulation 103 a nd mcle Boa rd Opinions available a t INSTRUCTIONS FOR COMPLETING APPLICATION FOR CLE APPROVAL (FORM 4) Please allow 90 days for board decision on all complete applications . ete a ttorney i nformation on l eft hand side. Complete identifyi ng sponsor i nformation on ri ght hand side of a l l in title of program l CLE hours a re the number of hours of COURSE instruction e xcluding i ntroductory re marks, breaks, meals, cl osing re marks. ONLY SESSIONS WITH WRITTEN INSTRUCTIONAL MATERIALS ARE APPROVABLE. Ke ynote , me altime speakers, judicial presentations or roundtable discussions are give n CLE cre dit only when written handout materials a re given to appropriately cove r the topic.

8 Vi rginia is a 60 mi nute state, meaning 60 mi nutes of i nstruction equals 1 CLE cre di l Ethics hours are the number of hours devoted to Ethics as it a pplies to a ttorneys. Ethics re lating to other professions, gove rnmente mpl oyees, business professionals or general e thics are not approva ble for Ethics cre dit. The Ethics time segment must be clearly de fined on the COURSE schedule a nd be a ccompanied by s pecific e thics materials. Ethics ma terial must be i ncluded with this APPLICATION . Pl ease s eeOpi nion #13 for a pprovable e thics ndicate type of COURSE , setting and delive ry me thod specific to the COURSE you attended. All distance learning courses require a statement from the sponsor on how their programs meet Opinion 16 standards. Pre s e ntations re sulting from the re ntal or purchase of vi deo or audio progra ms re quire 2 or more attorneys i n a ttendance a nd a ccompanied by a ppropriate wri tten instructional materials.

9 Please contact theMCLE office for special instructions and forms. ve the dates a nd l ocations of your attendance. The mcle re porting ye ar runs from November 1 - Octobe r 31. Cours es a re approve d for the re porting ye ar they a re presented a nd must be re ported during that r the price you paid for COURSE a ttendance. Ta rget audience: Courses must be directed primarily to a ttorneys a nd a ddress a l egal topic to be a pproved. Special a pproval may be give n for non-legal courses if pertinent to the ATTORNEY s practice. (See #11 below) ! Omission of any attachments/information will delay processing. Appl ication must include the following attachments: a . Progra m ti me s chedule or agenda. Ti mes are needed to compute a pprovable cre dit Ta bl e of contents AND a sample of the written materials (5-7 pages) from each session that you re ceived prior to or a t the cs materials must be s ubmitted to re ceive e thics cre dit.

10 COURSE materials must be arranged in order a nd be labeled if sessions are nota pparent. The mcle Boa rd re serves the ri ght to re quest a complete s et of rk whe n you re ceived the written ch a s tatement of how a non-legal COURSE re lates to your ication fe e: $25. $50 La te APPLICATION Fee re quired for a pplications re ceive d or that re main incomplete 90 da ys following theprogra m. $50 fe e re quired for in-house audio/video or CD-ROM a pplications. Ma ke your che ck payable to Tre asurer of ete a nd s ign certification of attendance. For te aching cre dit please a ttach the Form #3 Ce rti fication of Te aching.