(Please note that a copy of the published work must accompany your request for credit)
l. Name, address, and telephone number of applicant: _____________________________
__________________________________________________________________________
2. Title of the authored work ("work-product"):
______________________________________________________________________
3. Name of the publication in which it appeared:
______________________________________________________________________
4. Publication date: ______________________________________________________
5. Name, address, and telephone number of publisher: _________________________
_______________________________________________________________________
6. Does the publication have distribution to at least 300 attorneys? ______________
_______________________________________________________________________
7. Is the work-product an original work? _____________________________________
If no, explain: __________________________________________________________
______________________________________________________________________
8. Is the applicant the principal author of the work-product? If no, explain:
______________________________________________________________________
______________________________________________________________________
9. If the work-product was co-authored with another person, clearly describe which parts are attributed to the applicant (citing pages, sections or chapter headings):
______________________________________________________________________
______________________________________________________________________
10. Give name, address and telephone number of each co-author, and indicate the extent of that person's contribution to the work-product:
______________________________________________________________________
______________________________________________________________________
11. Estimate the number of hours expended by applicant in preparing the work-product and describe the hours expended:
______________________________________________________________________
12. State the number of credit hours sought by applicant:
______________________________________________________________________
13. State the calendar year for which credit is being sought:**
______________________________________________________________________
__________________________ Date |
____________________________________ Attorney Signature Required |
**Credit hours are allocated in the year in which the publication occurs.
Return to:
WV MCLE Commission
The West Virginia State Bar
2006 Kanawha Blvd. East, Charleston, WV 253ll-2204
(304) 558-7992
| APPROVED/DISAPPROVED | |
| Date: ___________________ | Credit Hours Approved ______________ |
| Conditions: | |
| [ ] Please note that the credits awarded will now be entered. | |
__________________________________________ MCLE Coordinator |
|
Send Comments to MCLE Coordinator Hope Gresham: greshamh@wvbar.org
 |
| The West Virginia State Bar |
| 2006 Kanawha Boulevard, East - Charleston,
WV 25311-2204 Phone: (304) 558-2456 - Fax: (304) 558-2467 - WV Toll Free: 866-989-8227 |
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