WV SPONSOR APPLICATION FOR ACCREDITATION OF MCLE
1. Sponsoring Organization (Name, Mailing Address):
| Name: __________________________________________________________ |
|
| Address: |
________________________________________________________________ ________________________________________________________________ |
| Phone: ____________________________ | Fax: ________________________________ |
2. Title of Educational Activity: ____________________________________________
3. Date(s) and Location (s):
| ________________________________________________________________ | |
| ________________________________________________________________ |
4. Registration Fee: __________________________
5. Writing Surface Available: _____________________________________________
6. Delivery Method(s):
| [ ] faculty in room with participants | [ ] telephone to broadcast site | [ ] interactive video |
| [ ] satellite | [ ] audiotape presentation | [ ]videotape presentation |
| [ ] interactive computer over internet | [ ] discussion leader present |
7. Advertised to: [ ] Lawyers; [ ] Clients; Others (specify, list %):
8. List any admission restrictions:
9."In-house activity" requirement (see local rules to determine applicability):
| [ ] open/publicized to outside lawyers | [ ]outsiders are _______ % of faculty | |
| [ ] clients are ______% of audience |
c10.Method of evaluation: [ ] participant critique; [ ] independent evaluator; [ ] none; [ ] other
11.Description of materials to be distributed:
Please indicate total number of pages for written materials [
]
| [ ] Looseleaf | [ ] Bound | ||
| [ ]Distributed Before Program | [ ] Distributed At Program | [ ] Other |
12. Required Attachments to this application:
| a. time schedule (brochure, outline, course description) | |
| b. table of contents or equivalent | |
| c. faculty name(s) and creditials (if not in brochure or description) | |
| d. $25 fee for each application (payable to the WV State Bar) |
13. Total MINUTES of instruction, not including breaks, meals,
or introductions/closing remarks:
| GENERAL (non-ethics): | _______________ | |
| Ethics (minutes): | _______________ | |
| Substance Abuse (minutes): | _______________ | |
| Office Management (minutes): | _______________ | |
| Elimination of Bias (minutes): | _______________ | |
TOTAL MINUTES: |
_______________ |
14. Approval by other states:
| Granted by: ___________________________________________________________ | |
| Denied by: ____________________________________________________________ |
15. Submitted by [ ] employee of sponsor/provider; [ ] individual lawyer
SPONSOR OBLIGATIONS: Sponsor acknowledges and agrees to comply with all local rules and regulations attached.
| Sponsor Representative: | ______________________________________________ |
| Signature: | ______________________________________________ |
| Title: | ______________________________________________ |
| Date: | ______________________________________________ |
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| STATE ACCREDITATION OFFICE DECISION (To be completed by the state accreditation office and returned to applicant) | |
| [ ] RETURNED for more information. Please complete each item on the form indicated by the number(s) circled: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 | |
| [ ] APPROVED for _______________________________ MCLE credits, including _____ Ethics/Office Mgmt/Substance Abuse/Elimination of Bias | |
| [ ] DENIED Reference: | |
| [ ] SEE ATTACHED MATERIALS | |
| DATE: ____________________________ | CLE Staff: _______________________________ |
 |
| 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 |
| All contents copyright (C) 1995-2001,
The WV State Bar. All rights reserved.
Last Revised: URL: |