FORM E

WV MCLE COMMISSION
FORM E - CERTIFICATION OF TEACHING OR PARTICIPATING
IN APPROVED MCLE COURSES
(Revised 10/02)

l. Name __________________________________________		WVSB ID# ____________
Address __________________________________________________________________________
City _____________________________	State ___________	Zip ____________

If new address for State Bar records, please check here [ ]

Attorney's Email: ____________________________________________________________

2. Educational Period covered: July l, _______ to June 30, ________

3. Name of Sponsor:

_____________________________________________________________

4. Title of course taught or participated in:

__________________________________________________________________________________

(Please note: Activity must be approved before seeking teaching credit.)

5. Date and location where course was presented:

__________________________________________________________________________________

6. Nature of participation (teacher, member of panel discussion, etc.): __________________________________________________________________________________
(Note: Do not use this form to report attendance only. Attendance is reported on Form C.)

7. Have you taught this course previously during the current two-year reporting period? ________________ If so, please provide the date and number of credits awarded for for teaching ___________________________________________________________

If teaching credits were awarded and the topic was the same (similar outline/handouts), no additional teaching credit can be awarded for the same activity during the current reporting period (SEE MCLE REGULATION 4 (A)(ll). If you presented a considerable amount of updated material, teaching credit may be awarded. Please provide a copy of your outline and/or written materials from both activities.

8. Based upon the following formulas, please indicate the number of teaching credits below:

Teacher/Instructor:

	_____	Spoke for at least 25-30 minutes: 3 credits
	_____	Spoke for at least 50-60 minutes: 6 credits
	_____	Spoke for at least two hours: 8 credits
	_____	Spoke for whole morning, whole afternoon, whole day, or more: l0 credits

(Please note that the maximum number of teaching credits available for teaching one activity, even a week long course, is ten credits.)

Panel Member:

	_____	Served on panel for at least 25-30 minutes: 1.50 credits
	_____	Served on panel for at least 50-60 minutes: 3.00 credits
	_____	Served on panel for at least two hours: 4.00 credits
	_____	Served on panel for whole morning, whole afternoon, or whole day: 5.00 credits

9. Please indicate the total minutes of instruction (if any) which included legal ethics, law office management, substance abuse or elimination of bias in the legal profession topics _________________________________________________________________

TOTAL TEACHING/PANEL DISCUSSION CREDITS EARNED _________

Date ________________________

Signature ______________________________________

Please note that your teaching credits will be confirmed by the MCLE Coordinator. The maximum credit available for teaching and/or participating in panel discussions in any two-year reporting period is l8 credits.

WV MCLE COMMISSION
WV STATE BAR
2006 KANAWHA BLVD EAST, CHARLESTON WV 25311
(304) 558-7992

------------------------------------------------------------------------------------------------------

Date:

Number of Credits Granted

[ ] Please be advised that the credits awarded will now be entered.

_______________________________________________________
Hope L. Gresham, MCLE Coordinator

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