REQUEST FOR ACCREDITATION OF TEACHING ACTIVITY …

REQUEST FOR ACCREDITATION OF TEACHING ACTIVITY

PURSUANT TO REGULATION 103.2

STATE OF COLORADO SUPREME COURT OFFICE OF CONTINUING LEGAL AND JUDICIAL EDUCATION 1300 Broadway, Suite 510 Denver, CO 80203 (303) 928-7771

PLEASE SUBMIT A SEPARATE FORM FOR EACH PROGRAM FOR WHICH YOU WANT CLE CREDITS

Office Use Approved for: General Credits

Ethics Credits

Accreditation denied:

FORM 5

Credit may be earned through teaching a program that has been accredited for CLE in Colorado or any other mandatory CLE jurisdiction. A registered lawyer or judge may earn five CLE credit hours for every 50 minutes spent in teaching an accredited CLE program or earn two CLE credits for every 50 minutes spent moderating or acting as panelist for an accredited CL program.

1. Name of person requesting teaching credit

2. Attorney Registration Number

3. Address

City

State

Zip Code

Country

Phone Number

email address

4. Name of program in which teaching activity occurred

5. Has this course been accredited for CLE in a mandatory CLE state or in Colorado:

No

Yes If yes, list state or CO course ID #

6. Name of program sponsor in which teaching activity occurred

7. Program date

Location: city/webinar

State

Country

8. Participated as:

Title of presentation Title of presentation Title of presentation

Is any portion devoted to ethics*?

Lecturing time (minutes) Lecturing time (minutes) Lecturing time (minutes)

If yes, lecturing time (minutes)

Signature

*See C.R.C.P. 250.5(3) for a definition of qualifying ethics.

Date

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